Selective progesterone receptor modulators (SPRMs) for uterine fibroids

Abstract

Short-term use of SPRMs resulted in improved quality of life, reduced menstrual bleeding and higher rates of amenorrhoea than were seen with placebo. Thus, SPRMs may provide effective treatment for women with symptomatic fibroids. Evidence derived from one RCT showed no difference between leuprolide acetate and SPRM with respect to improved quality of life and bleeding symptoms. Evidence was insufficient to show whether effectiveness was different between SPRMs and leuprolide. Investigators more frequently observed SPRM-associated endometrial changes in women treated with SPRMs than in those treated with placebo or leuprolide acetate. As noted above, SPRM-associated endometrial changes are benign, are not related to cancer and are not precancerous. Reporting bias may impact the conclusion of this meta-analysis. Well-designed RCTs comparing SPRMs versus other treatments are needed.

Epidemiology and management of uterine fibroids

“…Other SPRM members such as mifepristone, asoprisnil, vilaprisan and telapristone acetate have been investigated in phase 2 clinical trials with promising preliminary results. 18,25 A main concern for all progesterone-inhibiting agents is the potential for induced endometrial growth by the unopposed estrogens, which could lead to the development of endometrial hyperplasia/cancer, although not confirmed by clinical trials, and other non-malignant reversible histological findings. 24 For this reason, their long-term treatment safety profile is still under investigation.…”

The past, present, and future of selective progesterone receptor modulators in the management of uterine fibroids

“…As a class, the SPRMs have been shown to be effective for improving QoL, decreasing menstrual blood loss, and achieving amenorrhea. 9 There have been 2 randomized trials evaluating asoprisnil from 5-20 mg per day. These studies showed that asoprisnil is able to suppress uterine bleeding in a dosedependent manner in patients with UF.…”

Is ulipristal acetate the new drug of choice for the medical management of uterine fibroids? Res ipsa loquitur?

“…[2][3][4] The majority of women remain largely asymptomatic; however, they can cause debilitating symptoms in up to 30%. 3 Clinical features range from heavy menstrual bleeding to pain, pressure and subfertility, with symptom severity often depending on the number and position of the fibroids.…”

“…2 Furthermore, the use of UPA as postulated would potentially open a new frontier for the medical management of uterine fibroids. This will be in line with other gynaecological disorders, for example, ectopic pregnancy where management has gone from a purely surgical intervention to 30% of women being managed medically.…”