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Kanno K, Nakayama K, Razia S, Islam SH, Farzana ZU, Sonia SB, Yamashita H, Ishikawa M, Ishibashi T, Imamura K, Kiyono T, Kyo S. Association between KRAS and PIK3CA Mutations and Progesterone Resistance in Endometriotic Epithelial Cell Line. Curr Issues Mol Biol 2024; 46:3579-3594. [PMID: 38666954 PMCID: PMC11049223 DOI: 10.3390/cimb46040224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Although endometriosis is a benign disease, it is associated with cancer-related gene mutations, such as KRAS or PIK3CA. Endometriosis is associated with elevated levels of inflammatory factors that cause severe pain. In a previous study, we demonstrated that KRAS or PIK3CA mutations are associated with the activation of cell proliferation, migration, and invasion in a patient-derived immortalized endometriotic cell line, HMOsisEC10. In this study, we investigated the effects of these mutations on progesterone resistance. Since the HMOsisEC10 had suppressed progesterone receptor (PR) expression, we transduced PR-B to HMOsisEc10 cell lines including KRAS mutant and PIK3CA mutant cell lines. We conducted a migration assay, invasion assay, and MTT assay using dienogest and medroxyprogestrone acetate. All cell lines showed progesterone sensitivity with or without mutations. Regarding inflammatory factors, real-time quantitative RT-PCR revealed that the KRAS mutation cell line exhibited no suppression of Cox-2 and mPGES-1 on progesterone treatment, whereas IL-6, MCP-1, VEGF, and CYP19A1 were significantly suppressed by progesterone in both mutated cell lines. Our results suggest that KRAS mutation and PIK3CA mutation in endometriotic cells may not be associated with progesterone resistance in terms of aggressiveness. However, KRAS mutations may be associated with progesterone resistance in the context of pain.
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Affiliation(s)
- Kosuke Kanno
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-0021, Japan; (K.K.); (S.H.I.); (Z.U.F.); (S.B.S.); (H.Y.); (M.I.)
| | - Kentaro Nakayama
- Department of Obstetrics and Gynecology, Nagoya City University East Medical Center, Nagoya 464-8547, Japan;
| | - Sultana Razia
- Department of Legal Medicine, Faculty of Medicine, Shimane University, Izumo 693-0021, Japan;
| | - Sohel Hasibul Islam
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-0021, Japan; (K.K.); (S.H.I.); (Z.U.F.); (S.B.S.); (H.Y.); (M.I.)
| | - Zahan Umme Farzana
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-0021, Japan; (K.K.); (S.H.I.); (Z.U.F.); (S.B.S.); (H.Y.); (M.I.)
| | - Shahataj Begum Sonia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-0021, Japan; (K.K.); (S.H.I.); (Z.U.F.); (S.B.S.); (H.Y.); (M.I.)
| | - Hitomi Yamashita
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-0021, Japan; (K.K.); (S.H.I.); (Z.U.F.); (S.B.S.); (H.Y.); (M.I.)
| | - Masako Ishikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-0021, Japan; (K.K.); (S.H.I.); (Z.U.F.); (S.B.S.); (H.Y.); (M.I.)
| | - Tomoka Ishibashi
- Department of Obstetrics and Gynecology, Nagoya City University East Medical Center, Nagoya 464-8547, Japan;
| | - Kayo Imamura
- Department of Obstetrics and Gynecology, Unnan City Hospital, Unnan 699-1221, Japan;
| | - Tohru Kiyono
- Project for Prevention of HPV-Related Cancer, National Cancer Center, Exploratory Oncology Research and Clinical Trial Center (EPOC), Kashiwa 277-8577, Japan;
| | - Satoru Kyo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-0021, Japan; (K.K.); (S.H.I.); (Z.U.F.); (S.B.S.); (H.Y.); (M.I.)
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Keukens A, Veth VB, Regis M, Mijatovic V, Bongers MY, Coppus SFPJ, Maas JWM. The effect of surgery or medication on pain and quality of life in women with endometrioma. A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 293:95-105. [PMID: 38134610 DOI: 10.1016/j.ejogrb.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
For patients with endometrioma it is unclear what treatment: surgery and/or medication, is more effective in reducing pain and improving quality of life (QoL). This systematic review and meta- analysis aimed to provide an overview of the existing evidence on the effects of surgery and/or medication (i.e. analgesics and/or hormonal medication) on pain and QoL. A search through CENTRAL, MEDLINE and Embase was conducted. The study population had to be women treated for endometrioma. Retrospective or prospective studies reporting about QoL and/or the following types of pain were reviewed: dysmenorrhea, dyspareunia, chronic pelvic pain, and pain that was not well defined in the included article (referred to as pain). We performed a meta-analysis on mean visual analogue scale (VAS) scores and proportions of patients experiencing different types of pain over time. QoL was described narratively. Out of 11.515 articles, 76 studies including 7148 patients were included for the systematic review. The meta-analysis consisted of 52 studies including 4556 patients. No studies compared medication with surgery. And there were no studies on analgesics. Meta-analysis showed that surgery and/or medication often reduced VAS scores and proportions of all types of pain over time. Surgery and medication combined seems more effective in reducing VAS scores of pain compared to surgery alone, but not to medication alone (estimated mean difference = 0.17, p < 0.0001 and -0.98, p = 0.0339). QoL improved after medication (follow up ≤ 12 months) and QoL was unchanged or worsened after surgery and medication combined (follow up ≤ 24 months). However, these were results from a total of 5 studies. Both surgery and medication reduce endometriosis-related pain in patients with endometrioma. However, there is lack of uniform, good quality data comparing surgery with medication to draw firm conclusions. For better-informed treatment decisions, further studies including a standardized core-outcome set at fixed follow-up times, are necessary.
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Affiliation(s)
- A Keukens
- Department of Gynecology, Máxima Medical Center, Veldhoven, the Netherlands; Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, the Netherlands.
| | - V B Veth
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht, the Netherlands
| | - M Regis
- Department of Mathematics and Computer Science, Eindhoven University of Technology, De Zaale, Eindhoven, the Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - M Y Bongers
- Department of Gynecology, Máxima Medical Center, Veldhoven, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht, the Netherlands
| | - S F P J Coppus
- Department of Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
| | - J W M Maas
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht, the Netherlands
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Muzii L, Di Tucci C, Galati G, Carbone F, Palaia I, Bogani G, Perniola G, Tomao F, Kontopantelis E, Di Donato V. The Efficacy of Dienogest in Reducing Disease and Pain Recurrence After Endometriosis Surgery: a Systematic Review and Meta-Analysis. Reprod Sci 2023; 30:3135-3143. [PMID: 37217824 PMCID: PMC10643411 DOI: 10.1007/s43032-023-01266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
The objective of this study is to determine whether dienogest therapy after endometriosis surgery reduces the risk of recurrence compared with placebo or alternative treatments (GnRH agonist, other progestins, and estro-progestins). The design used in this study is systematic review with meta-analysis. The data source includes PubMed and EMBASE searched up to March 2022. A systematic review and meta-analysis were performed in accordance with guidelines from the Cochrane Collaboration. Keywords such as "dienogest," "endometriosis surgery," "endometriosis treatment," and "endometriosis medical therapy" were used to identify relevant studies. The primary outcome was recurrence of endometriosis after surgery. The secondary outcome was pain recurrence. An additional analysis focused on comparing side effects between groups. Nine studies were eligible, including a total of 1668 patients. At primary analysis, dienogest significantly reduced the rate of cyst recurrence compared with placebo (p < 0.0001). In 191 patients, the rate of cyst recurrence comparing dienogest vs GnRHa was evaluated, but no statistically significant difference was reported. In the secondary analysis, a trend toward reduction of pain at 6 months was reported in patients treated with dienogest over placebo, with each study reporting a significantly higher reduction of pain after dienogest treatment. In terms of side effects, dienogest treatment compared with GnRHa significantly increased the rate of spotting (p = 0.0007) and weight gain (p = 0.03), but it was associated with a lower rate of hot flashes (p = 0.0006) and a trend to lower incidence of vaginal dryness. Dienogest is superior to placebo and similar to GnRHa in decreasing rate of recurrence after endometriosis surgery. A significantly higher reduction of pain after dienogest compared with placebo was reported in two separate studies, whereas a trend toward reduction of pain at 6 months was evident at meta-analysis. Dienogest treatment compared with GnRHa was associated with a lower rate of hot flashes and a trend to lower incidence of vaginal dryness.
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Affiliation(s)
- Ludovico Muzii
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico, 155-00161, Rome, Italy.
| | - Chiara Di Tucci
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico, 155-00161, Rome, Italy
| | - Giulia Galati
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico, 155-00161, Rome, Italy
| | - Fabiana Carbone
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico, 155-00161, Rome, Italy
| | - Innocenza Palaia
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico, 155-00161, Rome, Italy
| | - Giorgio Bogani
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico, 155-00161, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico, 155-00161, Rome, Italy
| | - Federica Tomao
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico, 155-00161, Rome, Italy
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Greater Manchester, Manchester, UK
| | - Violante Di Donato
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico, 155-00161, Rome, Italy
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Zhang Z, Wang X, Wang L, Li Z. Cost-effectiveness Analysis of Dienogest Compared with Combined Oral Contraceptives after Surgery for Endometriosis. J Minim Invasive Gynecol 2022; 30:312-318. [PMID: 36596391 DOI: 10.1016/j.jmig.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Abstract
STUDY OBJECTIVE To assess the cost-effectiveness of different strategies, including the dienogest (DNG) and combined oral contraceptives (COC) therapy, for the prevention of endometriosis recurrence after surgery. DESIGN A decision tree model was created. The analysis was based on data from a healthcare provider in China. Model inputs were derived from published data. The end points included incremental cost effectiveness ratio, net monetary benefit (NMB), and incremental NMB associated with prevention of recurrence. The uncertainty was assessed through one way and probabilistic sensitivity analysis. The Consolidated Health Economic Evaluation Reporting Standards 2022 checklist was used to assess quality of the reporting. SETTING China healthcare system. PATIENTS Individuals undergoing laparoscopic surgery for endometriosis. INTERVENTIONS DNG vs COC. MEASUREMENTS AND MAIN RESULTS The base case analysis showed that hormone supression via DNG resulted in 0.7493 quality-adjusted life years (QALYs) at a cost of $1625.49 compared with COC, which resulted in 0.7346 QALYs at a cost of $343.61. The incremental cost effectiveness ratio was $87 679.89 per additional QALY gained and the DNG treatment was associated with an incremental NMB of -$731.39. Probabilistic sensitivity analysis indicated that DNG is not cost-effective in most cases at a threshold consistent with World Health Organisation recommendations of $37 653/QALY. CONCLUSION The result of our present analysis suggests that the DNG might not be cost-effective for the prevention of endometriosis recurrence after surgery in China.
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Affiliation(s)
- Zhixian Zhang
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou (Drs. Zhang, Wang and Wang)
| | - Xiaoli Wang
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou (Drs. Zhang, Wang and Wang)
| | - Lei Wang
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou (Drs. Zhang, Wang and Wang)
| | - Zhenghong Li
- Department of Pharmacy, The Fourth Affiliated Hospital of Nanchang University, Nanchang (Dr. Li), China.
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Harada T, Taniguchi F, Kitajima M, Kitawaki J, Koga K, Momoeda M, Mori T, Murakami T, Narahara H, Osuga Y, Yamaguchi K. Clinical practice guidelines for endometriosis in Japan (The 3rd edition). J Obstet Gynaecol Res 2022; 48:2993-3044. [PMID: 36164759 PMCID: PMC10087749 DOI: 10.1111/jog.15416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Tasuku Harada
- Department Obstetrics and Gynecology, Tottori University
| | | | | | - Jo Kitawaki
- Department Obstetrics and Gynecology, Kyoto Prefectural University of Medicine
| | - Kaori Koga
- Department Obstetrics and Gynecology, The University of Tokyo
| | - Mikio Momoeda
- Department Obstetrics and Gynecology, Aiiku Hospital
| | - Taisuke Mori
- Department Obstetrics and Gynecology, Kyoto Prefectural University of Medicine
| | - Takashi Murakami
- Department Obstetrics and Gynecology, Shiga University of Medical Science
| | | | - Yutaka Osuga
- Department Obstetrics and Gynecology, The University of Tokyo
| | - Ken Yamaguchi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
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Choi SH, Kim SE, Lim HH, Lee DY, Choi D. Efficacy of Post-Operative Medication to Prevent Recurrence of Endometrioma: Cyclic Oral Contraceptive (OC) After Gonadotropin-Releasing Hormone (GnRH) Agonist Versus Dienogest. J Korean Med Sci 2022; 37:e207. [PMID: 35790209 PMCID: PMC9259244 DOI: 10.3346/jkms.2022.37.e207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/30/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There are several medical treatment options for endometrioma. Progestin, especially dienogest, is an effective drug for preventing recurrence of endometrioma after surgery. Additionally, oral contraceptive (OC) use after conservative surgery has been reported to reduce significantly the risk of endometrioma recurrence. The aim of this study was to compare the long-term effects of gonadotropin-releasing hormone (GnRH) agonist followed by OC to those of dienogest alone to prevent recurrence of endometrioma after laparoscopic surgery. METHODS A retrospective cohort study was performed on patients who underwent conservative laparoscopic surgery for endometrioma between January 2000 and December 2020, in the Endometriosis Clinic, Department of Gynecology, Samsung Medical Center. A total of 624 patients who received medical treatment at least six months after laparoscopic conservative surgery for endometrioma was included. Among them, 372 patients used OC after GnRH agonist therapy, and 252 patients used dienogest. Within the OC group, 148 used a 21/7 regiment and 224 used a 24/4 regimen. A cumulative endometrioma recurrence curve was presented using the Kaplan-Meier method to compare the recurrence of those groups. RESULTS The cumulative recurrence rate of endometrioma for 60 months was 2.08% (n = 4) in the OC after GnRH agonist group and 0.40% (n = 1) in the dienogest group. There was no statistical difference in cumulative recurrence of endometrioma between the two groups. In subgroup analysis, the cumulative recurrence rate of endometrioma over 60 months was 4.21% (n = 2) in the 21/7 OC group and 1.09% (n = 2) in the 24/4 OC group and showed no significant difference. CONCLUSION Long-term use of OC after GnRH agonist as well as that of dienogest treatment are effective postoperative medical therapies for preventing endometrioma recurrence. Thus, the choice of regimen can be individualized or used interchangeably depending on patient condition, need for contraception, and compliance with drug therapy.
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Affiliation(s)
| | | | - Hyun Hye Lim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - DooSeok Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Lertvikool S, Tingthanatikul Y, Hongsakorn W, Srisombut C, Nakpalat K, Weerakiet S. Outcomes of Laparoscopic Partial Cystectomy of Bladder Endometriosis: A Report of 18 Thai Women. WOMEN'S HEALTH REPORTS 2021; 2:369-374. [PMID: 34671756 PMCID: PMC8524725 DOI: 10.1089/whr.2021.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
Aim: To determine the outcomes of laparoscopic partial cystectomy (LPC) for bladder endometriosis (BE). Methods: This was a retrospective study using medical records of women who underwent LPC for BE between January 2009 and December 2017. Demographic characteristics, surgical findings, including surgical site and size of the bladder lesion, endometriosis at other locations, and pre- and postoperative hormonal treatment data were collected. Results: We analyzed data of 18 women with full-thickness BE. The patients had a mean age of 34 (range, 26–45) years and body mass index of 21.6 (range, 16.1–25) kg/m2. All women had dysmenorrhea. Other symptoms noted include dysuria, gross hematuria, and infertility. BE with a mean diameter of 2.7 cm (range, 1–5) was most commonly found at the posterior wall of the bladder (94.4%). Peritoneal endometriosis (94.4%), endometrioma (33.3%), and deep endometriotic nodules (22.2%) in the posterior compartment were also found. No surgical complications were observed. Postoperative hormonal treatment was administered to 14 (77.8%) patients. All symptoms improved after the surgery. No recurrence was found after 30 (range, 12–74) months of follow-up. Conclusion: LPC is an effective treatment option for BE.
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Affiliation(s)
- Srithean Lertvikool
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yada Tingthanatikul
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Woradej Hongsakorn
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chartchai Srisombut
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Katanyuta Nakpalat
- Women Health Centre, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhon Royal Academy, Bangkok, Thailand
| | - Sawaek Weerakiet
- Division of Obstetrics and Gynecology, Bangkok Hospital Udonthani, Udonthani, Thailand
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Seo YS, Yuk JS, Cho YK, Shin JY. Dienogest and the Risk of Reoperation in Endometriosis. J Pers Med 2021; 11:jpm11090924. [PMID: 34575701 PMCID: PMC8470369 DOI: 10.3390/jpm11090924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/01/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background: This retrospective cohort study aimed to determine whether there is a difference in reoperation rates between patients who used dienogest (DNG) and patients who did not use DNG. Methods: Using Health Insurance Review and Assessment Service (HIRA) data generated between 1 January 2010 and 30 June 2018, we identified women with an endometriosis diagnosis code who used GnRH agonists after gynecological surgery. Among them, women prescribed DNG were selected as the DNG group, and those who did not receive DNG were selected as the control group. A survival analysis of the reoperation between the two groups was performed. Results: DNG and control groups were extracted from 9735 people each. The reoperation rates were 0.4% and 0.6% in the DNG and control groups, respectively, without adjusting. In the Cox proportional risk analysis, DNG use increased the reoperation rate {hazard ratio (HR), 1.599; 95% confidence interval (CI), 1.005–2.545}. The site of endometriosis and the number of GnRH agonist injections were not associated with reoperation (HR, 1.008; 95% CI, 0.739–1.374; HR, 1.062; 95% CI, 0.690–1.635). In the subgroup survival analysis, according to the period between the last GnRH agonist injection and the first DNG dose, DNG did not increase the reoperation rates up to 9 months (~3 months: HR, 0.968; 95% CI, 0.551–1.699; 4~6 months: HR, 1.094; 95% CI, 0.58–2.063; 7~9 months: HR, 2.419; 95% CI, 0.735–7.962), but DNG increased the reoperation rate from 10 months onwards (10~12 months: HR, 3.826; 95% CI, 1.164–12.579 and ~13 months: HR, 8.436; 95% CI, 4.722–15.072). Conclusions: Women who used DNG had a higher endometriosis reoperation rate than women who did not use DNG. However, the initiation of DNG treatment within nine months after the last GnRH agonist injection did not affect the endometriosis reoperation rate.
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Affiliation(s)
- Yong-Soo Seo
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, 1342, Dongil-ro, Nowon-gu, Seoul 01757, Korea; (Y.-S.S.); (Y.-K.C.)
| | - Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, 1342, Dongil-ro, Nowon-gu, Seoul 01757, Korea; (Y.-S.S.); (Y.-K.C.)
- Correspondence: ; Tel.: +82-2-950-8847; Fax: +82-303-3446-3369
| | - Yong-Kyoon Cho
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, 1342, Dongil-ro, Nowon-gu, Seoul 01757, Korea; (Y.-S.S.); (Y.-K.C.)
| | - Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
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Becker K, Heinemann K, Imthurn B, Marions L, Moehner S, von Stockum S, Gerlinger C, Serrani M, Faustmann T. Patient-reported utilization patterns of endometriosis medications in Europe: Real-world results from the non-interventional VIPOS study. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2021. [DOI: 10.1177/22840265211035993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Women with endometriosis require individualized, long-term treatment. Analyzing prescription choices, medication switches, discontinuations, and breaks can describe real-world treatment patterns and optimize pathways for women. To our knowledge, the Visanne Post-approval Observational Study (VIPOS) is the largest real-world, non-interventional study examining the safety of hormonal treatments for the routine clinical management of endometriosis. We present data from VIPOS on endometriosis drug utilization patterns, including treatment discontinuation due to treatment failure. Methods: VIPOS was a prospective, long-term, controlled, non-interventional cohort study in six European countries (Germany, Switzerland, Russia, Poland, Ukraine, and Hungary) conducted between 2010 and 2018. Women self-reported medical and gynecological history and symptoms and treatment information via comprehensive questionnaires. Results: Overall, 27,840 women were enrolled via gynecologists or specialized centers. Inter-country variance in treatment prescription patterns suggests the influence of differential management strategies and guidelines on prescribing behavior and diagnostic methods. Most enrolled women were receiving combined hormonal contraceptives. Women receiving dienogest 2 mg or gonadotropin-releasing hormone agonists more often had a surgical diagnosis of endometriosis compared to other treatments, while most women receiving combined hormonal contraceptives, other progestins or danazol had a symptom-based diagnosis. Although treatment changes during follow-up were common, only 4733 discontinuations out of 42,342 treatment starts were reported due to side effects or treatment ineffectiveness. Conclusion: VIPOS provides valuable insights into the considerable inter-country variance in endometriosis treatment prescription and potential role of differing management guidelines and practices strategies. Findings presented here suggest the need greater alignment of clinical practice to optimize patient management.
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Affiliation(s)
| | | | - Bruno Imthurn
- Formerly of Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - Lena Marions
- Department of Clinical Science and Education Karolinska Institutet, Stockholm, Sweden
| | | | | | - Christoph Gerlinger
- Statistics and Data Insights, Bayer AG, Berlin, Germany
- Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany
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Burghaus S, Schäfer SD, Beckmann MW, Brandes I, Brünahl C, Chvatal R, Drahoňovský J, Dudek W, Ebert AD, Fahlbusch C, Fehm T, Fehr PM, Hack CC, Häuser W, Hancke K, Heinecke V, Horn LC, Houbois C, Klapp C, Kramer H, Krentel H, Langrehr J, Matuschewski H, Mayer I, Mechsner S, Müller A, Müller A, Müller M, Oppelt P, Papathemelis T, Renner SP, Schmidt D, Schüring A, Schweppe KW, Seeber B, Siedentopf F, Sirbu H, Soeffge D, Weidner K, Zraik I, Ulrich UA. Diagnosis and Treatment of Endometriosis. Guideline of the DGGG, SGGG and OEGGG (S2k Level, AWMF Registry Number 015/045, August 2020). Geburtshilfe Frauenheilkd 2021; 81:422-446. [PMID: 33867562 DOI: 10.1055/a-1380-3693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 01/16/2023] Open
Abstract
Aims The aim of this official guideline published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG) in cooperation with the Austrian Society for Gynaecology and Obstetrics (OEGGG) and the Swiss Society for Gynaecology and Obstetrics (SGGG) was to provide consensus-based recommendations for the diagnosis and treatment of endometriosis based on an evaluation of the relevant literature. Methods This S2k guideline represents the structured consensus of a representative panel of experts with different professional backgrounds commissioned by the Guideline Committee of the DGGG, OEGGG and SGGG. Recommendations Recommendations on the epidemiology, aetiology, classification, symptomatology, diagnosis and treatment of endometriosis are given and special situations are discussed.
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Affiliation(s)
| | - Sebastian D Schäfer
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Münster, Münster, Germany
| | | | - Iris Brandes
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Germany
| | - Christian Brünahl
- Institut für Psychosomatische Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Wojciech Dudek
- Thoraxchirurgie, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas D Ebert
- Praxis für Frauengesundheit, Gynäkologie & Geburtshilfe, Berlin, Germany
| | | | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Carolin C Hack
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Winfried Häuser
- Klinik für Innere Medizin 1 (Gastroenterologie, Hepatologie, Onkologie, Stoffwechsel- und Infektionskrankheiten, Psychosomatik), Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | | | | | | | - Christian Houbois
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Köln, Germany
| | - Christine Klapp
- Ärztliche Gesellschaft zur Gesundheitsförderung e. V. Hamburg, Charité - Universitätsmedizin Berlin Klinik für Geburtsmedizin, Berlin, Germany
| | - Heike Kramer
- Ärztliche Gesellschaft zur Gesundheitsförderung e. V. Hamburg, Spardorf, Germany
| | - Harald Krentel
- Klinik für Frauenheilkunde, Geburtshilfe, Gynäkologische Onkologie und Senologie, Ev. Krankenhaus BETHESDA, Duisburg, Germany
| | - Jan Langrehr
- Allgemein-, Gefäß- und Viszeralchirurgie, Martin Luther Krankenhaus, Berlin, Germany
| | | | - Ines Mayer
- EVA - Endometriose Vereinigung Austria e. V., Wien, Austria
| | - Sylvia Mechsner
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Müller
- Frauenklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Armelle Müller
- EVA - Endometriose Vereinigung Austria e. V., Wien, Austria
| | - Michael Müller
- Universitätsklinik für Frauenheilkunde, Universitätsspital Bern, Bern, Switzerland
| | - Peter Oppelt
- Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum, Linz, Austria
| | | | - Stefan P Renner
- Klinik für Frauenheilkunde und Geburtshilfe, Kliniken Böblingen, Böblingen, Germany
| | - Dietmar Schmidt
- MVZ für Histologie, Zytologie und molekulare Diagnostik, Trier, Germany
| | | | | | - Beata Seeber
- Universitätsklinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Department Frauenheilkunde, Innsbruck, Austria
| | | | - Horia Sirbu
- Thoraxchirurgie, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Daniela Soeffge
- Endometriose-Vereinigung Deutschland e. V., Leipzig, Germany
| | - Kerstin Weidner
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Isabella Zraik
- Urologie, KEM
- Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Uwe Andreas Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin Luther Krankenhaus, Berlin, Germany
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11
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Moehner S, Becker K, Lange JA, von Stockum S, Serrani M, Heinemann K. Long-term treatment of endometriosis with dienogest: Real-world results from the VIPOS study. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2021. [DOI: 10.1177/2284026521993688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The Visanne Post-approval Observational Study (VIPOS) was designed to assess the safety of dienogest 2 mg (DNG, Visanne) compared to other hormonal endometriosis treatments. Methods: Large, prospective, non-interventional, active surveillance study in six European countries (Germany, Poland, Russia, Hungary, Switzerland, and Ukraine). Women with a new hormonal therapy for endometriosis were enrolled by gynecologists and specialized centers between 2010 and 2016 and observed for up to 7 years. Self-administered questionnaires during study entry and follow-up collected information on baseline characteristics, health status and endometriosis treatment. Self-reported clinical outcomes of interest were validated by health care professionals. Results: Among the >27,000 enrolled participants, 3262 women started DNG use either at study entry or during follow-up. A total of 798 study participants used DNG during follow-up continuously for 15 months or longer (DNG long-term users). When comparing the occurrence of serious adverse events (SAE) in users treated with DNG, no safety signal emerged for long-term users; the SAE incidence rate per 10,000 women-years was 367.7 (95% CI: 274.1–481.9) in DNG long-term users and 416.4 (349.1–492.5) in short-term users (treated with DNG for less than 15 months). Conclusions: Previous data on DNG long-term safety were derived from studies with relatively low numbers of patients and limited follow-up time. VIPOS provided valuable real-world data on the long-term use of DNG 2 mg in around 800 women treated in Europe and observed no safety signal regarding serious adverse events.
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Affiliation(s)
- Sabine Moehner
- ZEG—Berlin Center for Epidemiology and Health Research, Berlin, Germany
| | - Kerstin Becker
- ZEG—Berlin Center for Epidemiology and Health Research, Berlin, Germany
| | - Jens A Lange
- ZEG—Berlin Center for Epidemiology and Health Research, Berlin, Germany
| | | | - Marco Serrani
- Global Medical Affairs Women's Health Care, Bayer Pharma AG, Berlin, Germany
| | - Klaas Heinemann
- ZEG—Berlin Center for Epidemiology and Health Research, Berlin, Germany
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Choi J, Jo M, Lee E, Lee DY, Choi D. Dienogest regulates apoptosis, proliferation, and invasiveness of endometriotic cyst stromal cells via endoplasmic reticulum stress induction. Mol Hum Reprod 2021; 26:30-39. [PMID: 31814016 DOI: 10.1093/molehr/gaz064] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/25/2019] [Indexed: 02/06/2023] Open
Abstract
Dienogest, a specific progesterone receptor agonist, is used in the treatment of endometriosis. However, it is still unclear as to the mechanisms of therapeutic effects on endometriosis. Our recent study showed that endometriosis may be the result of aberrant endoplasmic reticulum (ER) stress induction due to progesterone resistance. This finding suggests that the regulation of ER stress induction may play a key role in treatment of endometriosis. Therefore, the anti-endometriotic effects of dienogest may be mediated by regulation of ER stress. To test this hypothesis, we elucidate whether dienogest affects endometriotic stromal cell apoptosis, proliferation and invasiveness by modulating ER stress-induced CCAAT/enhancer-binding protein homologous protein (CHOP) expression. Specifically, PRKR-like ER kinase (PERK)/eukaryotic initiation factor 2α (eIF2α)/activating transcription factor 4 (ATF4), inositol-requiring kinase 1 (IRE1)/TNF receptor-associated factor 2 (TRAF2)/apoptosis signal-regulating kinase 1 (ASK1)/c-Jun N-terminal kinase (JNK) signaling, and downstream CHOP were evaluated to determine the involved ER stress-mediated regulation mechanism of CHOP expression. Our results show that progesterone treatment did not have any significant effects on ER stress, apoptosis, proliferation, and invasion in estrogen-treated endometriotic cyst stromal cells (ECSCs). However, dienogest treatment upregulated the induction of ER stress. It also led to increased apoptosis, and decreased proliferation and invasiveness. These dienogest-induced changes in apoptosis, proliferation and invasiveness were reversed by the ER stress inhibitor salubrinal. Furthermore, dienogest-induced ER stress increased CHOP expression through activation of both PERK/elf2α/ATF4 and IRE1/TRAF2/ASK1/JNK signaling. This upregulation was blocked by transfection with PERK and IRE1 siRNA, which decreased apoptosis and increased the proliferation and invasiveness of dienogest-treated ECSCs. Taken together, our findings indicate that dienogest enhances ER stress induction in endometriotic stromal cells, which affects apoptosis, proliferation and invasiveness via CHOP upregulation.
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Affiliation(s)
- JongYeob Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 06351, Korea
| | - MinWha Jo
- Center for Clinical Research, Samsung Biomedical Research Institute, 50 Irwon-dong, Gangnam-gu, Seoul 06351, Korea
| | - EunYoung Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 06351, Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 06351, Korea
| | - DooSeok Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 06351, Korea
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13
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Zakhari A, Edwards D, Ryu M, Matelski JJ, Bougie O, Murji A. Dienogest and the Risk of Endometriosis Recurrence Following Surgery: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:1503-1510. [PMID: 32428571 DOI: 10.1016/j.jmig.2020.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE To determine whether dienogest therapy after endometriosis surgery reduces the risk of endometriosis recurrence compared with expectant management. DATA SOURCES Ovid MEDLINE, Ovid EMBASE, PubMed, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, clinicaltrials.gov, and International Standard Randomized Controlled Trial Number Registry were searched from inception to March 2019 for observational and randomized controlled trials. METHODS OF STUDY SELECTION The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Medical Subject Heading terms and keywords such as "dienogest," "endometriosis," and "recurrence" were used to identify relevant studies. TABULATION, INTEGRATION, AND RESULTS The search yielded 328 studies, 10 of which were eligible for inclusion, representing 1184 patients treated with dienogest and 846 expectantly managed controls. Among these studies, 9 looked exclusively at endometrioma recurrence, whereas 1 used reappearance of symptoms as evidence of disease recurrence. Data on both incidence of and time to recurrence of endometriosis were extracted. The incidence rate of endometriosis recurrence in patients treated with dienogest was 2 per 100 women over a mean follow-up of 29 months (95% confidence interval [CI], 1.43-3.11) versus 29 per 100 women managed expectantly over a mean follow-up of 36 months (95% CI, 25.66-31.74). The likelihood of recurrence was significantly reduced with postoperative dienogest (log odds -1.96, CI, -2.53 to -1.38, p <.001). CONCLUSION Patients receiving dienogest after conservative surgery for endometriosis had significantly lower risk of postoperative disease recurrence than those who were expectantly managed.
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Affiliation(s)
- Andrew Zakhari
- Department of Obstetrics and Gynecology, McGill University Health Center, Montreal, QC, Canada (Drs. Zakhari, Edwards, and Murji)
| | - Darl Edwards
- Department of Obstetrics and Gynecology, McGill University Health Center, Montreal, QC, Canada (Drs. Zakhari, Edwards, and Murji)
| | - Michelle Ryu
- Department of Mount Sinai Hospital, Sidney Liswood Health Sciences Library, Toronto, ON, Canada (Ms. Ryu)
| | - John J Matelski
- Mount Sinai Hospital, University of Toronto, Toronto, Biostatistics Research Unit, University Health Network, Toronto, Canada (Mr. Matelski)
| | - Olga Bougie
- Department of Obstetrics and Gynecology, Queen's University, Kingston General Hospital, Kingston (Dr. Bougie), Ontario, Canada
| | - Ally Murji
- Department of Obstetrics and Gynecology, McGill University Health Center, Montreal, QC, Canada (Drs. Zakhari, Edwards, and Murji).
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14
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Murji A, Biberoğlu K, Leng J, Mueller MD, Römer T, Vignali M, Yarmolinskaya M. Use of dienogest in endometriosis: a narrative literature review and expert commentary. Curr Med Res Opin 2020; 36:895-907. [PMID: 32175777 DOI: 10.1080/03007995.2020.1744120] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: Endometriosis affects up to 10% of women of reproductive age, and the main goal of treatment is to relieve symptoms. Progestins have been the mainstay of endometriosis suppression, of which dienogest has become an important option in many parts of the world. This is an expert literature review, with recommendations on the use of dienogest in the context of various clinical considerations when treating endometriosis.Methods: A search of PubMed was conducted for papers published between 2007 and 2019 on the use of dienogest in endometriosis. Experts reviewed these and included those they considered most relevant in clinical practice, according to their own clinical experience.Results: Evidence regarding the long-term use (>15 months) of dienogest for the management of endometriosis is presented, with experts concluding that the efficacy of dienogest should be assessed primarily on its impact on pain and quality of life. Fertility preservation, the option to avoid or delay surgery, and managing bleeding irregularities that can occur with this treatment are also considered. Counseling women on potential bleeding risks before starting treatment may be helpful, and evidence suggests that few women discontinue treatment for this reason, with the benefits of treatment outweighing any impact of bleeding irregularities.Conclusions: Overall, the evidence demonstrates that dienogest offers an effective and tolerable alternative or adjunct to surgery and provides many advantages over combined hormonal contraceptives for the treatment of endometriosis. It is important that treatment guidelines are followed and care is tailored to the woman's individual needs and desires.
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Affiliation(s)
- Ally Murji
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | | | - Jinhua Leng
- Peking Union Medical College Hospital, Beijing, China
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Thomas Römer
- Department of Obstetrics and Gynecology, Academic Hospital of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Michele Vignali
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Maria Yarmolinskaya
- Department of Gynecological Endocrinology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Saint Petersburg, Russia
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15
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Hidari T, Hirata T, Arakawa T, Koga K, Neriishi K, Fukuda S, Nakazawa A, Nagashima N, Ma S, Sun H, Takamura M, Harada M, Hirota Y, Wada-Hiraike O, Fujii T, Osuga Y. Contralateral ovarian endometrioma recurrence after unilateral salpingo-oophorectomy. BMC WOMENS HEALTH 2019; 19:59. [PMID: 31046768 PMCID: PMC6498560 DOI: 10.1186/s12905-019-0760-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/22/2019] [Indexed: 11/17/2022]
Abstract
Background The recurrence rate after unilateral salpingo-oophorectomy (USO) for unilateral endometrioma has not been reported. We evaluated the rate of and risk factors for endometrioma recurrence after USO. Methods In this retrospective observational study, we enrolled 110 women (age, 35–45 years) who underwent laparoscopic USO (n = 50) or cystectomy (n = 60) for unilateral ovarian endometrioma from January 2010 through December 2012. We compared patients’ characteristics between patients who underwent USO and those who underwent cystectomy. We also compared patients with and without an endometrioma recurrence after USO using univariate and multivariate stepwise logistic regression models to identify recurrence risk factors. Endometrioma recurrence was defined as an ovarian cyst (> 2 cm) with features typical of an endometrioma identified by postoperative transvaginal sonography. Results Endometrioma recurred in 8 (16%) patients after USO (mean follow-up, 46.0 ± 12.9 months [range, 15–73]). The post-USO cumulative recurrence rates at 12, 24, 36, and 60 months were 8.0, 10.2, 12.7, and 24.7%, respectively (Kaplan-Meier analysis). In logistic regression analysis, a contralateral side adhesion score ≥ 4 was an independent risk factor for endometrioma recurrence after USO (odds ratio, 19.48, 95% confidence interval, 1.59–237.72). The post-USO cumulative recurrence rates at 12, 24, 36, and 57 months were 19.5, 24.1, 31.0, and 54.0%, respectively, in cases with contralateral side adhesion scores ≥4, and 0.0, 0.0, 0.0, and 5.9%, respectively, in cases with scores < 4 (log-rank test, P = 0.0023). Conclusions To our knowledge, this is the first report on the recurrence rate and risk factors associated with recurrence after USO. Endometrioma recurrence rates were 24.7% during the first 5 years after USO. The post-USO recurrence rate increased significantly in cases with contralateral side adhesions. Our findings could improve the planning of USO and patient selection for postoperative hormonal therapy.
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Affiliation(s)
- Tokie Hidari
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tetsuya Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tomoko Arakawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuaki Neriishi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shinya Fukuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akari Nakazawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Natsuki Nagashima
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Suke Ma
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hui Sun
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masashi Takamura
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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16
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Chen Y, Wang H, Wang S, Shi X, Wang Q, Ren Q. Efficacy of ten interventions for endometriosis: A network meta‐analysis. J Cell Biochem 2019; 120:13076-13084. [PMID: 30937963 DOI: 10.1002/jcb.28579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/16/2019] [Accepted: 01/24/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Yan Chen
- The First College of Clinical Medicine Nanjing University of Chinese Medicine Nanjing Jiangsu China
| | - Hua Wang
- Department of Gynecology Taizhou Hospital Affiliated to Nanjing University of Chinese Medicine Taizhou China
| | - Saili Wang
- Department of Gynecology Taizhou Hospital Affiliated to Nanjing University of Chinese Medicine Taizhou China
| | - Xinying Shi
- Department of Acupuncture Taizhou Hospital Affiliated to Nanjing University of Chinese Medicine Taizhou China
| | - Qin Wang
- Department of Gynecology Taizhou Hospital Affiliated to Nanjing University of Chinese Medicine Taizhou China
| | - Qingling Ren
- Department of Gynecology Affiliated Hospital of Nanjing University of Chinese Medicine Nanjing China
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17
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Seo JW, Lee DY, Kim SE, Yoon BK, Choi D. Comparison of long-term use of combined oral contraceptive after gonadotropin-releasing hormone agonist plus add-back therapy versus dienogest to prevent recurrence of ovarian endometrioma after surgery. Eur J Obstet Gynecol Reprod Biol 2019; 236:53-57. [PMID: 30884336 DOI: 10.1016/j.ejogrb.2019.02.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to compare long-term use of combined oral contraceptive (COC) after gonadotropin-releasing hormone (GnRH) agonist plus add-back therapy with dienogest (DNG) treatment as medical treatments after surgery for ovarian endometrioma. METHODS This prospective cohort study analyzed 52 reproductive-aged women who underwent surgery for ovarian endometrioma and received postoperative medical treatment with either COC after GnRH agonist (n = 20) or DNG (n = 32) for 24 months. Changes in quality-of-life (QOL) and bone mineral density (BMD) were compared according to treatment. In addition, recurrence of pain and lesions were compared. RESULTS Baseline characteristics did not differ in demographic profiles and factors associated with endometriosis or QOL. During 24 months of treatment, no differences in any component of QOL were found between the two groups. BMD at the lumbar spine significantly decreased after the first 6 months of treatment in both COC after GnRH agonist (-3.5%) and DNG (-2.3%) groups, but the groups did not differ statistically. After 6 months, further decrease in BMD was not observed until 24 months in both groups. In addition, no cases of pain or endometrioma recurrence were found. CONCLUSION Our results suggest that long-term use of COC after GnRH agonist plus add-back therapy is comparable to dienogest as a long-term postoperative medical treatment for endometriosis.
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Affiliation(s)
- Jong-Wook Seo
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan hospital, Goyang, South Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Eun Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung-Koo Yoon
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - DooSeok Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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18
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Efficacy of levonorgestrel releasing intrauterine system as a postoperative maintenance therapy of endometriosis: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2018; 231:85-92. [PMID: 30336309 DOI: 10.1016/j.ejogrb.2018.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare the efficacy of levonorgestrel releasing intrauterine system (LNG-IUS) with other treatments as a postoperative maintenance therapy for endometriosis in terms of pain reduction, recurrence prevention, side effects and patients' satisfaction. STUDY DESIGN We searched MEDLINE, EMBASE, and the Cochrane Library from January 1986 until February 2018. Two evaluators independently extracted and reviewed prospective and retrospective articles based on pre-determined selection criteria. Outcomes were expressed as mean difference (MD), risk ratios (RR) or odds ratios (OR) in a meta-analysis model, using Revman software. RESULTS Among the 962 studies, 7 studies were selected: 7 studies included 4 randomized controlled trials with 212 patients, 1 prospective cohort study with 88 patients, and 2 retrospective studies with 191 patients. A meta-analysis showed that LNG-IUS was significantly effective in reducing pain after surgery (MD = 12.97, 95% confidence interval (CI): 5.55-20.39), with a comparable effect to gonadotropin-releasing hormone analogues (MD = -0.16, 95% CI: -2.02 to 1.70). LNG-IUS was also effective in decreasing the recurrence rate (RR = 0.40, 95% CI: 0.26-0.64), with an effect comparable to OC (OR = 1.00, 95% CI: 0.25-4.02) and danazol (RR = 0.30, 95% CI: 0.03-2.81). Furthermore, patients' satisfaction with LNG-IUS was significantly higher than that with OC (OR = 8.60, 95% CI: 1.03-71.86). However, vaginal bleeding was significantly higher in the LNG-IUS group than in the gonadotropin-releasing hormone analogue group (RR = 27.0, 95% CI: 1.71-425.36). CONCLUSION Our meta-analysis found a positive effect of LNG-IUS as a postoperative maintenance therapy for endometriosis on pain relief, prevention of dysmenorrhea recurrence, and patients' satisfaction.
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Ota K, Takahashi T, Shiraishi S, Mizunuma H. Combination of microwave endometrial ablation and postoperative dienogest administration is effective for treating symptomatic adenomyosis. J Obstet Gynaecol Res 2018; 44:1787-1792. [PMID: 29998482 DOI: 10.1111/jog.13720] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/02/2018] [Indexed: 01/04/2023]
Abstract
AIM Menorrhagia and dysmenorrhea are common symptoms. Uterine adenomyosis is one of the causes of menorrhagia and dysmenorrhea. These symptoms often decrease the quality of life in women. Microwave endometrial ablation (MEA) is a recently developed procedure that enables endometrial ablation. Dienogest has long been used to suppress endometrium development and reduce adenomyosis-related dysmenorrhea. However, some cases could be resistant to dienogest. In this study, we evaluated the efficacy of a combination of MEA and postoperative dienogest in reducing adenomyosis-related dysmenorrhea and menorrhagia. METHODS Ten patients with hormone treatment-resistant symptomatic adenomyosis underwent MEA and were administered oral dienogest after the procedure. The primary endpoints were reduction in pain recurrence and anemia. The secondary endpoint was a change in the adenomyosis lesion and its symptomatic recurrence. RESULTS Statistically significant improvements were seen in the visual analog scale score and hemoglobin levels in women post-treatment. The difference in myometrial thickness pre- and post-MEA was statistically significant. There were no cases of symptomatic recurrence. CONCLUSION The combination of MEA and postoperative dienogest is useful for treating uterine adenomyosis with menorrhagia and dysmenorrhea.
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Affiliation(s)
- Kuniaki Ota
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan.,Department of Obstetrics and Gynecology, Nasu Red Cross Hospital, Tochigi, Japan
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Satoru Shiraishi
- Department of Obstetrics and Gynecology, Nasu Red Cross Hospital, Tochigi, Japan
| | - Hideki Mizunuma
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
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Lee SR, Yi KW, Song JY, Seo SK, Lee DY, Cho S, Kim SH. Efficacy and Safety of Long-Term Use of Dienogest in Women With Ovarian Endometrioma. Reprod Sci 2017; 25:341-346. [DOI: 10.1177/1933719117725820] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sa Ra Lee
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Kyong Wook Yi
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, South Korea
| | - Jae Yen Song
- Department of Obstetrics and Gynecology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - SiHyun Cho
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Hoon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Dienogest inhibits C-C motif chemokine ligand 20 expression in human endometriotic epithelial cells. Eur J Obstet Gynecol Reprod Biol 2017; 214:65-70. [DOI: 10.1016/j.ejogrb.2017.04.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/24/2017] [Accepted: 04/28/2017] [Indexed: 12/12/2022]
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