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

Odejinmi, Funlayo; Annan, Henry; Mallick, Rebecca

doi:10.1016/j.ajog.2018.03.029

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…In 2015, the indications for UPA were extended to include intermittent treatment of women of reproductive age [36,37] based upon studies that advocated its use, even to enhance pregnancy outcomes [38,39]. This was despite concerns being raised around the methodology of those studies [40,41]. A systematic review of 'real life' data outside randomized controlled trials supported the efficacy of UPA for the management of symptomatic fibroids [42].…”

Section: A Cautionary Tale: the Ulipristal Acetate Challengementioning

confidence: 99%

Oral gonadotrophin-releasing hormone (GnRH) antagonists: the continuing search for the ideal nonsurgical therapy of uterine fibroids with a cautionary tale

Sim-Ifere,

Aref-Adib,

Odejinmi

2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Uterine fibroids are very common with a prevalence of over 70%. They present a significant economic and psychological burden. A variety of nonsurgical treatments exist for its management encompassing hormonal and nonhormonal methods. Gonadotrophin-releasing hormone (GnRH) antagonists are a novel treatment for uterine fibroids. They cause a rapid reduction in endogenous GnRH, leading to a dose-dependent reduction in levels of oestradiol and progesterone, thus reduction in bleeding. The addition of hormones, estrogen, and progesterone, known as add-back therapy, helps curb the menopausal side effects. As such, they pose a potential long-term nonsurgical therapy for management of symptomatic fibroids. Recent findings There are various uses of GnRH antagonists and the results from the clinical trials are promising. Caution needs to be taken when new treatment options are introduced with audit and data collection tools in place to assess effectiveness as well as any side effects. Summary This article highlights the uses of GnRH antagonists in practice and reflects on previous novel treatments for fibroids with a focus on Ulipristal acetate. It states the importance of using audit tools and multiinstitutional databases to prevent and allow early discovery of issues such as those that encumbered Ulipristal.

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Section: A Cautionary Tale: the Ulipristal Acetate Challengementioning

confidence: 99%

Oral gonadotrophin-releasing hormone (GnRH) antagonists: the continuing search for the ideal nonsurgical therapy of uterine fibroids with a cautionary tale

Sim-Ifere,

Aref-Adib,

Odejinmi

2023

Current Opinion in Obstetrics &Amp; Gynecology

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Vilaprisan, a New Selective Progesterone Receptor Modulator in Uterine Fibroid Pharmacotherapy-Will it Really be a Breakthrough?

Ciebiera

Vitale

Ferrero

et al. 2020

CPD

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Background: Vilaprisan (VPR) is a new orally available selective progesterone receptor modulator (SPRM), with anti-proliferative activity against uterine fibroids (UFs). It definitively causes suppression of ovulation and inhibition of proliferation of endometrial, myometrial and UF cells. Purpose: This review aims to summarize current knowledge on VPR from all studies, including clinical trials, conducted to date and to contextualize the potential role of VPR in future medical regimens for the treatment of UFs. Methods: We performed a literature search in PubMed US National Library of Medicine and Google Scholar databases. Both databases were extensively searched for all original and review articles/book chapters as well as congress abstracts published in English until July 2019. The use of VPR for UF therapy was identified by using the keywords: “uterine fibroids” and “vilaprisan”. Results: In phase I and II clinical trials, VPR was shown to be effective in ameliorating UF-related clinical symptoms, especially abnormal or excessive uterine bleeding and in shrinking UFs. The tolerability of VPR is roughly similar to that of ulipristal acetate (UPA) and it tends to be more favorable than that of GnRH-agonists. Conclusion: Presently, all trials examining the utility of VPR for the treatment of UF are halted; likely, due to the recently reported cases of hepato-toxicity with UPA, in addition to non reassuring toxicology results from preclinical long-term testing on rodents, carried out in parallel with late stage testing on humans. An accurate summary of robust data related to the safety of VPR is urgently needed to draw definitive conclusions on the future clinical development of this drug for UF therapy.

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

Cited by 2 publications

References 4 publications

Oral gonadotrophin-releasing hormone (GnRH) antagonists: the continuing search for the ideal nonsurgical therapy of uterine fibroids with a cautionary tale

Oral gonadotrophin-releasing hormone (GnRH) antagonists: the continuing search for the ideal nonsurgical therapy of uterine fibroids with a cautionary tale

Vilaprisan, a New Selective Progesterone Receptor Modulator in Uterine Fibroid Pharmacotherapy-Will it Really be a Breakthrough?

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