Ulipristal acetate for uterine fibroids: a systematic review and meta-analysis

Abstract

Ulipristal acetate (UA), a selective progesterone modulator, has been approved for short-term therapy for symptomatic fibroids. We decided to undertake a systematic review of the best available evidence and draw a more definitive conclusion regarding the efficacy of UA for the management of uterine fibroids. The outcomes included symptomatic relief, quality of life-related parameters, reduction in fibroid size, side effects and recurrence rate. We included four randomised controlled trials which consisted of three trials which compared UA with placebo, and one trial compared it with gonadotropin-releasing hormone analogues for symptomatic relief. The three trials comparing UA with placebo reported significant improvement in symptoms related to excessive uterine bleeding as evidenced by the attainment of amenorrhea or reduction in pictorial blood assessment chart. However, due to the heterogeneity of the available data, a meta-analysis was possible only for one the outcomes - attainment of amenorrhea which indicated improvement in symptoms [57.88 (19.81-169.16); p < 0.00001]. The improved quality of life parameters and reduction in fibroid size was noted in the UA group. With regards to adverse events, even though the three included studies reported increased non-physiological endometrial-related changes following UA, these changes reverted back to normal within 6 months. Short-term use of UA seems to be an effective and safe method of treating uterine fibroids.

A systematic review and meta‐analysis of ulipristal acetate for symptomatic uterine fibroids

“…Our findings are consistent with and extend those presented in a previous review . Their meta‐analysis was based on four studies and showed that UPA was associated with improved quality of life and reduced fibroid size compared with placebo.…”

Comparison between Mifepristone and Ulipristal acetate as an alternative to surgical management of uterine fibroids (Leiomyoma) in symptomatic patients of reproductive age group in Asian population

“…They concluded that Short-term use of Ulipristal acetate is effective and safe method of treating uterine fibroids. 20 All these findings were similar to findings of our study which showed that administration of Ulipristal acetate was associated with decreased blood loss and fibroid size consequently causing improved quality of life.…”

The use of selective progestin receptor modulators (SPRMs) and more specifically ulipristal acetate in the practice of gynaecology

“…In PEARL IV, 451 patients were treated for four recurrent 12‐week courses, with a daily dose of 5 or 10 mg UPA resulting in similar bleeding control, fibroid volume reduction and reassuring safety results . A systematic review and meta‐analysis of UPA as short‐term therapy for symptomatic fibroids included the RCTs mentioned earlier. Although they observed an improved quality of life and the reduction of fibroid size using UPA, they were unable to quantify a summarised improvement for most outcomes with the exception of amenorrhea, due to the heterogeneity of available data …”

“…A systematic review and meta‐analysis of UPA as short‐term therapy for symptomatic fibroids included the RCTs mentioned earlier. Although they observed an improved quality of life and the reduction of fibroid size using UPA, they were unable to quantify a summarised improvement for most outcomes with the exception of amenorrhea, due to the heterogeneity of available data …”