Ulipristal Acetate Versus Leuprolide Acetate for Uterine Fibroids

Donnez, Jacques; Tomaszewski, Janusz; Vázquez, Francisco; Bouchard, Philippe; Lemieszczuk, Boguslav; Baró, Francesc; Nouri, Kazem; Selvaggi, Luigi; Sodowski, Krzysztof; Bestel, Elke; Terrill, Paul; Osterloh, Ian H.; Loumaye, Ernest

doi:10.1097/ogx.0b013e318280a140

Cited by 132 publications

(324 citation statements)

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“…Los estudios de eficacia (PEARL I-IV) muestran que AU es un tratamiento seguro a nivel endometrial aunque provoca los cambios descritos que es necesario conocer (3)(4)(5)10). Durante dichos estudios, se realizaron por protocolo biopsias de endometrio de control antes y después de los ciclos trimestrales de tratamiento que fueron analizadas por 3 patólogos a ciegas y de forma independiente.…”

Section: Discussionunclassified

“…El tratamiento consiste en la administración de un comprimido de 5 mg vía oral una vez al día durante 3 meses, pudiendo repetirse este ciclo. La eficacia y seguridad del tratamiento ha sido documentada en primera instancia mediante varios ensayos clínicos aleatorizados en los que el AU se compara con placebo y a leuprorelina (análogo GnRH) (3,4). Estos primeros ensayos que constataron la eficacia y seguridad del fármaco valieron para aprobar el fármaco como tratamiento prequirúrgico de los miomas y el estudio más reciente (PEARL IV) ha servido para introducir en ficha técnica la indicación de tratamiento médico intermitente y no sólo de forma preoperatoria (5).…”

Section: Introductionunclassified

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Acetato de ulipristal en el diagnóstico diferencial de carcinoma de endometrio

Baquedano

Marqués

Calvo

et al. 2016

Rev. chil. obstet. ginecol.

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RESUMENLos miomas uterinos son las tumoraciones genitales más frecuentes cuyo tratamiento más habitual es el quirúrgico. Actualmente existe un tratamiento médico eficaz para reducir su volumen y la clínica asociada que es el acetato de ulipristal (AU), que es un modulador selectivo de los receptores de la progesterona. A nivel endometrial puede ocasionar cambios histológicos que cuando son muy marcados plantean dudas diagnósticas. Se presenta el caso de una paciente con útero miomatoso sintomático bajo tratamiento con AU, la histología en las muestras de biopsia planteó el diagnóstico diferencial con adenocarcinoma de endometrio. SUMMARYUterine fibroids are the most common genital tumors and the most common treatment is surgery. Actually there is an effective medical treatment to reduce its volume and the symptoms. It is ulipristal acetate (UA), a selective progesterone receptor modulator. In the endometrium it can cause some peculiar histological changes. We present a patient with symptomatic uterine fibroid with UA, and it was difficult to make differential diagnosis with endometrial cancer. INTRODUCCIÓNLos miomas uterinos o leiomiomas son los tumores más comunes de la mujer. Son de naturaleza benigna, derivan del músculo liso y tienen dependencia hormonal. Aparecen frecuentemente en la perimenopausia, de tal manera que después de los 40 años una de cada dos mujeres tienen miomas. Cuando son sintomáticos causan sangrado uterino que puede secundariamente provocar anemia, dismenorrea, dolor pélvico y otra sintomatología por compresión como poliaquiuria o tenesmo rectal. Por todo ello los leiomiomas son causa de una merma en la calidad de vida de la mujer y por ello un motivo frecuente de consulta ginecológica (1,2).El tratamiento más habitual para los miomas sintomáticos sigue siendo hoy en día la cirugía, bien sea conservando el útero o realizando una histerectomía. Teniendo en cuenta su dependencia hormonal en ocasiones se utilizan los análogos de la GnRH como tratamiento preoperatorio para disminuir su volumen y mejorar la anemia de las pacientes, sin embargo, sus importantes efectos adversos hacen que su utilidad sea limitada.El acetato de ulipristal (AU) es un modulador REV CHIL OBSTET GINECOL 2016; 81(2): 113 -116

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Section: Discussionunclassified

Section: Introductionunclassified

Acetato de ulipristal en el diagnóstico diferencial de carcinoma de endometrio

Baquedano

Marqués

Calvo

et al. 2016

Rev. chil. obstet. ginecol.

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“…En sık görülen yan etkiler baş ağrısı ve meme hassasiyeti olmuştur. GnRH analogları ile ulipristal asetatın karşılaştırıldığı randomize prospektif PEARL-II çalışmasında ise, 307 hasta 13 hafta boyunca 5 mg/gün ulipristal asetat, 10 mg/gün ulipristal veya 3,75 mg/ay leuprolid asetat tedavisine randomize edilmiştir (22). Ulipristal asetat kullanan grupta amenoreye kadar geçen zaman 5-7 gün kadar kısa olup GnRH analoglarına kıyasla daha kısa sürede ve daha fazla oranda kanama kontrolü sağladığı gösterilmiştir.…”

Section: Ulipristal Asetatunclassified

Medical Treatment of Leiomyomas

Uğurlucan¹,

Demir²,

Yaşa³

et al. 2017

İstanbul Tıp Fakültesi Dergisi

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ÖZETLeiomyomlar, reprodüktif çağda en sık görülen jinekolojik tümörlerdir. Leiomyomlar çoğu kadında bulunmakla beraber, bazı kadınlarda semptomatik hale gelmektedir. Genetik veya hormonal kökenli olabilirler. Leiomyomların üzerinde östrojen ve progesteron reseptörleri olması, onları hormona duyarlı hale getirmektedir. Leiomyomların ana tedavisi cerrahi olmakla beraber, cerrahi istemeyen veya fertilitesini korumak isteyen kadınlarda medikal tedaviler gündeme gelmektedir. Medikal tedavilerin çıkış noktası, leiomyomların hormona duyarlı olmasıdır. Medikal tedavi seçenekleri arasında gonadotropin-releasing-3 hormon analogları ve antagonistleri, aromataz inhibitörleri ve selektif progesteron reseptör modülatörleri yer almaktadır. Bu tedaviler kanama kontrolünün yanında leiomyom volümünde de küçülme sağlamaktadır. Bu derlemede bu tedavi yöntemlerine değinilecektir. Anahtar Kelimeler: Leiomyom; anormal uterin kanama; selektif progesteron reseptör modülatörleri; ulipristal asetat; anemi ABSTRACTLeiomyomas are the most common benign gynecological tumors observed during the reproductive period. Although, they are exceedingly common, not all are symptomatic. Leiomyomas are of genetic or hormonal origin and have estrogen and progesterone receptors, making them sensitive to hormones. The main treatment for leiomyomas is surgery, but in women who are not willing to undergo surgery or who want to preserve their fertility, medical treatment options may be used. The main basis of medical treatment in leiomyomas are hormones due to positive response to anti-hormonal therapies. Medical treatment options comprise gonadotropin-releasing-hormone agonists and antagonists, aromatase inhibitors, and selective progesterone receptor modulators. In addition to controlling bleeding, these treatment regimens cause a decrease in the volume of the tumor. In this review, treatment options are discussed.

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“…Дан-ные показания основываются на результатах 3 фазы серии исследований (PEARL I, PEARL II, PEARL III, PEARL IV), степень доказательности А1 [20,21,22]. Лечение эндометриоза пока не входит в показания для приема УПА.…”

Section: подходы к медикаментозному лечению сочетанной патологии маткиunclassified

Concomitant endometriosis and leiomyoma in women of reproductive age

Zaporozhchenko

Сидоренко

Парубина

2017

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Endometriosis and leiomyoma commonly co-exist inside one uterus. Specialized surgical centers report detection frequency of comorbid endometriosis during surgery or laparoscopy that varies from 20 to 87% in patients with symptomatic fibroids.In authors practice the histological study of surgery samples from patients diagnosed with symptomatic fibroids (113 hysterectomies) revealed concomitant endometriosis in 26.5% cases.Clinical and morphological analysis showed that in patients with multiply fibroids, large volumes or submucous myomas comorbid adenomyosis doesn’t interfere significantly with the clinic course. But in cases of small-size solitary intramural or subserosis fibroids the clinic of symptomatic myomas is determined by the comorbid adenomyosis of diffuse-nodular or diffuse-lesion forms and 2–3 stages.Thus, endometriosis associated with leiomyomas causes more severe course of comorbidity. Patients with symptomatic fibroids are exposed to higher risk of endometriosis development, which must be kept in mind when planning the surgery treatment. Authors propose to enhance laparoscopic myomectomy with target revision of pelvis to reveal possible endometriosis, because laparoscopy provides the best opportunity to visualization of endometriosis lesions.The choice of pharmacotherapy of concomitant uterine pathology is limited. Gonadotropin-releasing hormone agonists is the only currently available group of drugs that labeled both for the treatment of endometriosis and fibroids. Selective progesterone-receptor modulator ulipristal acetate due to its unique antiproliferative and selective proapoptotic effect on the leiomyomas cellular component is very promising in the uterine-sparing therapy of myomas. In addition, it has pharmacodynamic effects on the endometrium, including antiproliferative effects that may contribute to the treatment of endometriosis. Clinical trial of ulipristal on this indication is ongoing (NCT02213081). For the present, in the absence of approved algorithms for the treatment of co-morbid pathology, the individual approach with combining preparations of different classes is relevant.

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Ulipristal Acetate Versus Leuprolide Acetate for Uterine Fibroids

Cited by 132 publications

References 0 publications

Acetato de ulipristal en el diagnóstico diferencial de carcinoma de endometrio

Acetato de ulipristal en el diagnóstico diferencial de carcinoma de endometrio

Medical Treatment of Leiomyomas

Concomitant endometriosis and leiomyoma in women of reproductive age

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