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Jensen JT, Edelman A, Westhoff CL, Schreiber CA, Archer DF, Teal S, Thomas M, Brown J, Blithe DL. Use of serum evaluation of contraceptive and ovarian hormones to assess reduced risk of pregnancy among women presenting for emergency contraception in a multicenter clinical trial. Contraception 2024:110475. [PMID: 38670302 DOI: 10.1016/j.contraception.2024.110475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/06/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To evaluate ovulation risk among women enrolling in an emergency contraception (EC) study by measuring contraceptive steroids and ovarian hormones. STUDY DESIGN We used standard chemoluminescent assays to evaluate endogenous hormones [estradiol (E2), progesterone (P4), FSH, LH] and liquid chromatography-tandem triple quadrupole mass spectrometry (LC-MS/MS) to simultaneously analyze concentrations of ethinylestradiol (EE), dienogest (DNG), norelgestromin (NGMN), norethindrone (NET), gestodene (GSD), levonorgestrel (LNG), etonogestrel (ENG), segesterone acetate (NES), medroxyprogesterone acetate (MPA), and drospirenone (DRSP), in serum samples obtained at the time of enrollment in a recent study comparing oral ulipristal acetate and LNG EC in women with weight ≥ 80kg reporting no recent use of hormonal contraception. RESULTS We enrolled 532 and obtained a valid baseline blood sample from 520 women. Of these, 117 (22.5%) had detectable concentrations of a progestin [MPA (n=58, 11.2%), LNG (50, 9.6%), ENG (11, 2.1%), NET (5, 0.96%), NGMN (3, 0.06%), or DRSP (1, 0.02%)]. LNG was co-detected in all three participants with samples containing NGMN. Multiple progestins were detected in 8 other women: ENG/MPA (1); ENG/LNG (2); MPA/LNG (5). Samples from 55 (10.6%) had concentrations of one or more progestin considered above the minimum level for contraceptive [MPA ≥ 0.1ng/mL, n = 19; NGMN/LNG ≥ 0.2ng/mL, n = 31; ENG ≥ 0.09 ng/mL, n = 8; NET ≥ 0.35 ng/mL, n = 4]. We detected concentrations of serum P4 ≥ 3ng/mL, indicative of luteal phase (post-ovulation) status, in an additional 194 (37.3%) samples. CONCLUSIONS More than one third of enrolled in our clinical trial of oral emergency contraception had evidence of prior ovulation at the time of enrollment. Additionally, about 23% had evidence of recent use of hormonal contraception recent use of hormonal contraception. This results would have decreased the expected risk of pregnancy in the study. IMPLICATIONS Many participants in a recent clinical trial of oral emergency contraception did not appear to be at risk for pregnancy or would not have benefited from intervention due to cycle timing. Investigators should consider the effects of these findings on expected pregnancy rates when determining sample size in future EC clinical trials, particularly when using non-inferiority designs or historical controls.
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Affiliation(s)
| | | | | | | | - David F Archer
- Clinical Research Center, Department of Obstetrics and Gynecology, Eastern Virginia Medical School
| | | | | | - Jill Brown
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Diana L Blithe
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
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Evangelisti G, Ferrero S, Perrone U, Gustavino C, Volpi E, Izzotti A, Barra F. Experimental and new investigational drugs for the treatment of uterine fibroids. Expert Opin Investig Drugs 2024:1-12. [PMID: 38618931 DOI: 10.1080/13543784.2024.2343786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/12/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Uterine fibroids, the most prevalent benign tumors among reproductive-age women, pose treatment challenges that range from surgical interventions to medical therapies for symptom control. Progestins and estroprogestins effectively manage uterine bleeding by suppressing dysfunctional endometrium over fibroids. While GnRH agonists represent a crucial milestone in symptom treatment, their prolonged use results in menopausal-like symptoms and irreversible bone mineral density loss. Advancements in understanding fibroid pathophysiology have prompted the exploration of new compounds to overcome current therapy limitations. AREAS COVERED This manuscript offers an updated overview of investigational drugs for symptomatic uterine fibroids. EXPERT OPINION Despite ulipristal acetate's well-established efficacy as a selective progesterone receptor modulator (SPRM) in fibroid treatment, its prescription has declined due to the rare but severe risk of liver damage. Oral GnRH antagonists, like elagolix, relugolix, and linzagolix, with their novel pharmacodynamic properties, are gaining traction in fibroid management, inducing a dose-dependent reduction in circulating sex hormone levels. Ongoing research on natural compounds, such as vitamin D and epigallocatechin gallate (EGCG), presents emerging options for treating uterine fibroids. This evolving landscape reflects the ongoing efforts to improve therapeutic outcomes for individuals with symptomatic uterine fibroids.
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Affiliation(s)
- Giulio Evangelisti
- Unit of Obstetrics and Gynecology, San Paolo Hospital - ASL2, Savona, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Umberto Perrone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Gustavino
- Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Eugenio Volpi
- Unit of Obstetrics and Gynecology, San Paolo Hospital - ASL2, Savona, Italy
| | - Alberto Izzotti
- Unit of Mutagenesis and Cancer Prevention, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Fabio Barra
- Unit of Obstetrics and Gynecology, P.O. "Ospedale del Tigullio"- ASL4, Chiavari, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Blake BN, Bookbinder S, Lazenby G, Marshall A, Weed E, Meglin M. Knowledge of Oral Emergency Contraception Among Pharmacy Students. Womens Health Rep (New Rochelle) 2024; 5:40-45. [PMID: 38288390 PMCID: PMC10823165 DOI: 10.1089/whr.2023.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/31/2024]
Abstract
Background Access to emergency contraception is an important consideration in preventing unintended pregnancies. Inconsistent information about emergency contraceptive given to patients at retail pharmacies may limit access. Objective In this study, we aimed to assess pharmacy students' knowledge of oral emergency contraception. Methods Students in a Doctor of Pharmacy program completed a confidential survey about their knowledge of and training on oral emergency contraception. Respondents self-reported demographics included age, race, ethnicity, gender, and year in pharmacy school. The survey questions assessed student knowledge of indications, availability, side effects, and mechanisms of action of oral emergency contraception, as well as their training on emergency contraception. Chi-squared and Fisher's exact tests were used to determine if demographics influenced knowledge outcomes. A multivariate logistic regression, including age, gender, ethnicity, religion, year of training, hours of education, and source of knowledge acquisition, was used to adjust for confounding variables. Results Among 296 pharmacy students, 31% (92/296) completed the survey. Among respondents, 34% (31/92) showed adequate knowledge of oral emergency contraception based on four critical knowledge questions. Third- and fourth-year students were more likely to have adequate knowledge than first- and second-year students (odds ratio [OR], 2.70; confidence interval [95% CI], 1.07-6.80). Students who reported learning about emergency contraception through reading assignments were more likely to have adequate knowledge than students who did not report learning from reading assignments (OR, 2.09; 95% CI, 1.30-3.35). Conclusions Most pharmacy students at a single academic center did not have adequate knowledge of oral emergency contraception. These findings highlight the need for trainings to improve pharmacy student knowledge of oral emergency contraception.
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Affiliation(s)
- Bria Nikole Blake
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Samantha Bookbinder
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gweneth Lazenby
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amari Marshall
- College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elizabeth Weed
- Department of Clinical Pharmacy and Outcome Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michelle Meglin
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
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Scendoni R, Cingolani M, Cembriani F, Fedeli P, Tambone V, Terranova C, De Micco F. Over-the-counter emergency contraception in Italy: ethical reflections and medico-legal issues. Front Glob Womens Health 2023; 4:1205208. [PMID: 37790088 PMCID: PMC10544570 DOI: 10.3389/fgwh.2023.1205208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/06/2023] [Indexed: 10/05/2023] Open
Abstract
Although more than ten years have passed since the marketing of Ulipristal acetate in Europe, emergency contraception remains a complex issue with many scientific, legal, ethical and social implications. The topic is an example of the differences that can exist between scientific evidence, the certainties on which law is based, and social implications. This paper shows the incompleteness of the scientific reconstruction on the effects of emergency hormonal contraceptives and the dangerousness of the decision to alienate the supply of over-the-counter drugs from the general rules of health care. This report shows the incompleteness of the scientific reconstruction on the effects of emergency hormonal contraceptives and the dangerousness of the decision to alienate the supply of over-the-counter drugs from the general rules of health care. Various ethical and medico-legal issues will be addressed, also focusing attention on underage women whose sexual and reproductive health requires not abandoning them, but actually taking charge of them without medicalizing their choices.
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Affiliation(s)
- Roberto Scendoni
- Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy
| | - Mariano Cingolani
- Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy
| | - Fabio Cembriani
- Operative Unit of Legal Medicine, Provincial Authority for Health Services of Trento, Trento, Italy
| | | | - Vittoradolfo Tambone
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Corrado Terranova
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Gynaecology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Francesco De Micco
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
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Lambrecht I, Van den Bosch T. The use of a short course of Ulipristal Acetate for acute abnormal uterine bleeding in women without uterine fibroids. Facts Views Vis Obgyn 2023; 15:99-105. [PMID: 37436045 PMCID: PMC10410647 DOI: 10.52054/fvvo.15.2.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Ulipristal Acetate (UPA) is a synthetic selective progesterone receptor modulator. It is used as emergency contraception and to reduce pain and blood loss in women of reproductive age with uterine fibroids. The first mechanism of action is myometrial apoptosis, the second is on the hypo-thalamic-pituitary-ovarian axis and the third action, is an anti-proliferative effect on the endometrium. Mainly based on the latter two, UPA is increasingly used off-label in women with abnormal uterine bleeding (AUB) without fibroids. OBJECTIVES The aim of this paper is to find evidence for a short course of UPA to treat acute AUB without fibroids, performing a systematic review as well as scrutinising literature data on the pharmacokinetics and on short term bleeding control in women with fibroids. MATERIALS AND METHODS A systematic electronic literature review was performed in February 2022. Inclusion criteria were UPA administered to women without myomas in a setting of acute uterine bleeding. Further criteria included papers describing early bleeding control using UPA, deemed independent of the presence of fibroids, with specific attention to the median time to amenorrhoea. MAIN OUTCOME MEASURES The main outcome measured was the bleeding control within 10 days. RESULTS One case report was identified. The data on symptomatic women with fibroids using 5 mg or 10 mg daily revealed bleeding control was reported within 10 days in 81% and 89% respectively, with amenorrhoea in 57% and in 78% respectively. CONCLUSION A short-term administration may prove effective in abnormal uterine bleeding irrespective of the presence of uterine fibroids. However, more randomised controlled trials are needed and should be performed before implementation in general clinical practice. WHAT IS NEW? A short course of Ulipristal acetate as promising treatment for acute uterine bleeding without fibroids.
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Choice of contraceptives. Med Lett Drugs Ther 2023; 65:73-80. [PMID: 37155255 DOI: 10.58347/tml.2023.1676a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Rosenberg JD, Westhoff CL. Using transvaginal ultrasounds for the identification of follicle-like structures ≥10 mm in a multi-center randomized contraceptive clinical trial of three 84-day oral ulipristal acetate regimens. J Clin Ultrasound 2023; 51:454-461. [PMID: 36495483 DOI: 10.1002/jcu.23405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/02/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE We examine the use of transvaginal sonography in imaging ovarian follicles among non-pregnant reproductive-aged women enrolled in a contraceptive clinical trial. METHODS Ten sites conducted a clinical trial comparing three oral ulipristal acetate regimens for ovulation inhibition. Enrollees underwent twice weekly transvaginal sonography and hormonal blood testing throughout treatment and until the second menses post-treatment. The primary outcome of the present analysis was success in identifying follicles ≥10 mm in a subgroup of sonograms performed at times of likely follicular activity (estradiol <100 pg/ml and progesterone >3 ng/ml). Secondarily, an overall analysis assessed all sonograms regardless of timing. RESULTS At times of likely follicular activity, 135 women underwent 969 sonograms. The proportion of sonograms without follicles ≥10 mm ranged from 8.3% to 46.3% when stratified by site (p = .01). The odds of no follicle among higher-body mass index (BMI) women were 1.91 times those among lower-BMI women after controlling for site and treatment arm (95% CI: 1.13, 3.22). Results were similar for the overall population. CONCLUSION Sonographers were less likely to identify follicles for higher-BMI women and results varied by site. Machine quality slightly impacted sonogram results, but did not sufficiently explain site differences.
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Affiliation(s)
- Jessica D Rosenberg
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
- Guttmacher Institute†, New York, New York, USA
| | - Carolyn L Westhoff
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
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Gonçalves-Henriques M, de Pinho A, Freixo M, Liz-Coelho M, Castro F, Ceschin N, Brandão P. Ulipristal Acetate in Adenomyosis. Gynecol Minim Invasive Ther 2022; 11:198-202. [PMID: 36660320 PMCID: PMC9844051 DOI: 10.4103/gmit.gmit_95_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/19/2021] [Accepted: 12/17/2021] [Indexed: 11/05/2022] Open
Abstract
Adenomyosis is defined as the invasion of the basal endometrium (stroma and glands) into the underlying myometrium. It may lead to abnormal uterine bleeding (AUB), pelvic pain, and infertility. The definitive treatment is hysterectomy. Some conservative measures have been used in patients willing to procreate. Ulipristal acetate is a selective progesterone receptor modulator used to treat AUB caused by leiomyomas. This is a systematic review on the use of ulipristal to treat adenomyosis. Eight eligible articles were retrieved from PubMed, SCOPUS, and Cochrane Library. Only one randomized clinical trial was published until date concerning this matter. It seems that ulipristal acetate induces partial or complete remission of AUB caused by adenomyosis, but the evidence concerning its effect on pelvic pain and the radiologic findings of the disease is conflicting. Nevertheless, given the paucity of data, it is still preliminary to draw any conclusion about the subject.
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Affiliation(s)
- Manuel Gonçalves-Henriques
- Department of Obstetrics and Gynaecology, Hospital Prof. Doutor Fernando da Fonseca, Amadora, Lisbon, Portugal
| | - António de Pinho
- Department of Obstetrics and Gynaecology, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal,Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Marília Freixo
- Department of Obstetrics and Gynaecology, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Maria Liz-Coelho
- Department of Obstetrics and Gynaecology, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Fabiana Castro
- Department of Obstetrics and Gynaecology, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Nathan Ceschin
- Department of Reproductive Medicine, Instituto Valenciano de Infertilidad - IVIRMA Valencia, Valencia, Spain,Feliccita Fertility Clinics, Curitiba, Paraná, Brazil
| | - Pedro Brandão
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal,Department of Reproductive Medicine, Instituto Valenciano de Infertilidad - IVIRMA Valencia, Valencia, Spain,Address for correspondence: Dr. Pedro Brandão, Instituto Valenciano de Infertilidad, Plaza de la Policia Local 3, 46015, Valencia, Spain. E-mail:
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Cosyns S, Dony N, Tournaye H, Polyzos NP. Ultrasonographic appearance of the endometrium after saline infusion in women presenting with PRM-associated endometrial changes, due to the use of ulipristal acetate. J OBSTET GYNAECOL 2022; 42:2888-2892. [PMID: 36017902 DOI: 10.1080/01443615.2022.2111516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Ulipristal acetate (UPA), used for the treatment in women with symptomatic fibroids, is associated with endometrial changes visualised on ultrasound as thickening up to more than 16 mm in approximately 10% of the patients. Is saline infusion sonography (SIS) a good alternative for more invasive techniques, to evaluate the presence of intrauterine pathology? Ten patients, presenting with UPA associated endometrial changes at their follow up ultra-sonographic evaluation, were included. Our study demonstrated that SIS is feasible and painless in patients presenting with UPA associated endometrial changes. The thickened endometrium appears to divide at the midline, making it possible to study both layers separately and exclude any suspected intrauterine pathology. Our findings suggest that SIS may be a first choice, non-invasive, painless technique to provide a proper visualisation to rule out intrauterine pathology when UPA associated endometrial changes are diagnosed after fibroid treatment. This is especially of clinical interest in front of assisted reproductive technology treatment. Invasive techniques can be withheld for patients in whom SIS examination is not contributive.Impact StatementWhat is already known on this subject? Reversible endometrial changes after ulipristal acetate (UPA) treatment in patients with symptomatic fibroids have been described. In patients who receive UPA, especially if planned to undergo ART, assessment of potential endometrial pathology is important as such interfere with proper implantation after ART. Consequently, clinicians may consider ruling out intrauterine pathology by invasive examinations such as biopsy or hysteroscopy after visualisation of the thickened endometrium.What do the results of this study add? Saline infusion sonography (SIS) was feasible and painless in patients presenting with UPA associated endometrial changes.What are the implications of these findings for clinical practice and/or further research? SIS may be a first choice, non-invasive, painless technique to provide a proper visualisation to rule out intrauterine pathology when UPA associated endometrial changes are diagnosed after fibroid treatment. This is especially of clinical interest in front of assisted reproductive technology treatment. Invasive techniques can be withheld for patients in whom SIS examination is not contributive in excluding intrauterine pathology.
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Affiliation(s)
- Stefan Cosyns
- Department of Gynecology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZBrussel), Brussels, Belgium
| | - Noëlie Dony
- Department of Gynecology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZBrussel), Brussels, Belgium
| | - Herman Tournaye
- Department of Fertility, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZBrussel), Brussels, Belgium
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Leon-Larios F, Ruiz-Ferron C, Jalon-Neira RM, Praena-Fernández JM. Nursing Students' Knowledge, Awareness, and Experiences of Emergency Contraception Pills' Use. J Clin Med 2022; 11:jcm11020418. [PMID: 35054112 PMCID: PMC8780468 DOI: 10.3390/jcm11020418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 02/04/2023] Open
Abstract
The emergency contraception pill (ECP) is a non-prescribed medication in Spain. However, there is not enough evidence of its use among young people to define sex education contents. The aims of this research were to describe the experiences of the use of the ECP in university students and analyze their knowledge, attitude, and awareness regarding the ECP. The cross-sectional, analytic study was conducted with nursing degree students at the University of Seville. A total of 478 students answered the questionnaire. All of the students (100%) had heard about the ECP and had a positive attitude towards this contraceptive. A total of 25.7% had used the ECP, mainly because a condom had failed or because they did not use any contraceptive at all. Deficiencies in knowledge are related with the ECPs' mechanism of action, efficacy after repeated use, and the type of ECP available. Female students who used no method at all or withdrawal, and who were over 20 years old, used ECP to a greater extent (p < 0.005). Further education initiatives focused on the use of the ECP, its efficacy, and typology are needed, particularly among future health professionals who will later educate other young people.
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Affiliation(s)
- Fatima Leon-Larios
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (F.L.-L.); (J.-M.P.-F.)
| | - Cecilia Ruiz-Ferron
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (F.L.-L.); (J.-M.P.-F.)
- University Hospital Virgen del Rocío, 41013 Seville, Spain
- Correspondence:
| | | | - Juan-Manuel Praena-Fernández
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (F.L.-L.); (J.-M.P.-F.)
- Unit Biostatistic, Department of Statistics, Faculty of Medicine, University of Granada, 18016 Granada, Spain
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Park JY, Chae B, Kim MR. The Potential of Transforming Growth Factor-beta Inhibitor and Vascular Endothelial Growth Factor Inhibitor as Therapeutic Agents for Uterine Leiomyoma. Int J Med Sci 2022; 19:1779-1786. [PMID: 36313223 PMCID: PMC9608041 DOI: 10.7150/ijms.75203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Uterine leiomyoma is the most common benign tumor in women of reproductive age, and it can cause infertility. The growth of uterine leiomyoma is mediated by various steroids and growth factors. The purpose of this study was to evaluate the expression of various growth factors in uterine leiomyoma. Additionally, comparing the effects of existing medication and specific growth factor inhibitors on leiomyoma and the normal myometrium, we aimed to see the potential of transforming growth factor-beta (TGF-β) inhibitors and vascular endothelial growth factor (VEGF) inhibitors as therapeutic drugs for uterine leiomyoma. Methods: This in vitro study included uterine leiomyoma samples from 12 patients who underwent hysterectomy by laparoscopy or laparotomy at Seoul St. Mary's Hospital between May 2016 and March 2018. Normal myometrium and uterine leiomyoma tissue were obtained from each patient and the expression of growth factors was compared using immunohistochemical staining. After the primary culture of normal myometrial and leiomyoma cells, cell viability was evaluated following treatment with 100 nM ulipristal acetate (UPA) and mifepristone for 48 h. Western blot analysis was performed to determine the protein expression of each growth factor. Cell viability was determined following treatment with a 10-µM TGF-β inhibitor (LY364947) and a 5-µM VEGF inhibitor (axitinib) for 24 h in cultured normal myometrium and leiomyoma cells. Results: Immunohistochemical staining revealed the significantly higher intensity of TGF-β and VEGF in the leiomyoma tissue than in the normal myometrium (P < 0.05). Mifepristone treatment decreased VEGF expression by 62% in the leiomyoma cells (P < 0.05). According to the cell counting kit-8 (CCK-8) assay, cell viability was decreased after UPA, mifepristone, TGF-β1 inhibitor, and VEGF inhibitor treatments in the normal myometrium and leiomyoma tissue. The effects of the TGF-β1 inhibitor significantly differed between normal myometrium and leiomyoma tissue, with a greater decrease in cell survival in the leiomyoma tissue (P < 0.05). Post-hoc analysis showed that the TGF-β1 and VEGF inhibitors had a greater inhibitory effect on leiomyoma tissue compared with that of UPA. Conclusion: TGF-β and VEGF inhibitors significantly decreased the viability of uterine leiomyoma cells, showing stronger effects than the conventional drug, UPA. TGF-β1 inhibitors affect both leiomyoma tissue and the normal uterus; thus, targeted local treatment rather than systemic treatment should be considered.
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Affiliation(s)
- Jung Yoon Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Boah Chae
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Mee-Ran Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
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Stone RH, Gross S, Reardon B, Young HN. Emergency Contraception Access and Counseling in Metropolitan and Nonmetropolitan Pharmacies in Georgia. J Pharm Pract 2021; 36:523-531. [PMID: 34881653 DOI: 10.1177/08971900211052821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Emergency contraception (EC) efficacy is dependent on timing of administration. Adequate pharmacy stock information and accurate patient counseling are important to ensure timely access. Objective: This study evaluates pharmacist reported availability and counseling for levonorgestrel (LNG) and ulipristal acetate (UPA), and identifies differences between caller type and pharmacies in metropolitan vs nonmetropolitan areas of Georgia. Methods: This prospective, randomized, telephone-based study included 25% of Georgia community pharmacies, stratified by geographic location. Calls were made by investigators, first posing as a mystery shopper inquiring about EC stock and efficacy, then 3-6 weeks later as a researcher inquiring about EC stock. Analysis utilized descriptive statistics, chi Square, and logistic regression. Results: Of 600 pharmacies, the mystery shopper caller reached 86%: 74% of pharmacists initially discussed LNG, 57.1% had it stocked, more often in metropolitan areas (OR 1.7, 95% CI 1.08-2.6). Ulipristal acetate was discussed by 1.9% and reported in-stock < 1%. Of those who discussed window of efficacy, 79% indicated LNG would either not work 4 days after intercourse or they were unsure. The research caller successfully completed a second call for 64% of pharmacies: 57% stocked LNG, 3% stocked UPA, and UPA was more likely to be stocked in metropolitan pharmacies. Conclusion: In Georgia, UPA availability is poor, and nonmetropolitan pharmacies were less likely to stock LNG and UPA. A minority of pharmacists correctly indicated that LNG may work up to 120 hours after intercourse. Strategies are needed to overcome barriers to EC availability in community pharmacies and support pharmacists' EC counseling.
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Affiliation(s)
- Rebecca H Stone
- Department of Clinical and Administrative Pharmacy, 1355University of Georgia College of Pharmacy, Athens, GA, USA
| | - Savannah Gross
- 15506University of Georgia College of Pharmacy, Athens, GA, USA
| | - Brielle Reardon
- Department of Pharmacy, 1466Johns Hopkins Hospital, Baltimore, MD, USA
| | - Henry N Young
- Department of Clinical and Administrative Pharmacy, 1355University of Georgia College of Pharmacy, Athens, GA, USA
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Kolanska K, Sbeih M, Canlorbe G, Mekinian A, Varinot J, Capmas P, Koskas M, Aractingi S, Daraï E, Chabbert-Buffet N. Ulipristal Acetate Modifies miRNA Expression in Both Superficial and Basal Layers of the Human Endometrium. J Clin Med 2021; 10:jcm10194442. [PMID: 34640460 PMCID: PMC8509688 DOI: 10.3390/jcm10194442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/05/2022] Open
Abstract
(1) Background: Ulipristal acetate (UPA) is a selective progesterone receptor modulator (SPRM) widely used for emergency contraception and mid- to long-term leiomyoma treatment. The aim of this study was to identify modifications of miRNA expression in superficial and basal layers of the human endometrium at the end of the UPA treatment for at least 3 months. (2) Methods: Microarray miRNA analysis of formalin-fixed, paraffin-embedded hysterectomy tissue samples was conducted, followed by an Ingenuity Pathway Analysis. Samples were divided into three groups: women having had 3 months of UPA treatment (n = 7); and two control groups of UPA-naïve women in the proliferative (n = 8) or secretory (n = 6) phase. (3) Results: The UPA modified the expression of 59 miRNAs involved in the processes of cell cycle, carcinogenesis, and inflammation. Their expression profiles were different in the basal and superficial layers. Most of the processes influenced by the UPA in the basal layer were connected to the cell cycle and immune regulation. (4) Conclusion: Specific changes were observed in both layers of the endometrium in the UPA group. However, the miRNA expression in the basal layer was not consistent with that in the superficial layer. Other large studies analysing the long-term impact of SPRM on endometrial miRNA expression are necessary.
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Affiliation(s)
- Kamila Kolanska
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Service de Gynécologie Sestertius et Médecine de la Reproduction, AP-HP Sorbonne Université Site Tenon, 4 rue de la Chine, 75020 Paris, France
- Correspondence:
| | - Maria Sbeih
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
| | - Geoffroy Canlorbe
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75013 Paris, France
| | - Arsène Mekinian
- Service de Médecine Interne, AP-HP Sorbonne Université Site St Antoine, 184 rue du Faubourg Saint Antoine, 75012 Paris, France;
| | - Justine Varinot
- Service d’Anatomopathologie, AP HP Sorbonne Université Site Tenon, 4 rue de la Chine, 75020 Paris, France;
| | - Perrine Capmas
- Department of Gynecology and Obstetrics, University Paris Saclay, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France;
- Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, 94276 Le Kremlin-Bicêtre, France
| | - Martin Koskas
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Department of Obstetrics and Gynecology, AP-HP Bichat University Hospital, 75018 Paris, France
- Institut de Recherche en Santé de la Femme, Equipe d’accueil 7285, Universite de Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France
| | - Selim Aractingi
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
| | - Emile Daraï
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Service de Gynécologie Sestertius et Médecine de la Reproduction, AP-HP Sorbonne Université Site Tenon, 4 rue de la Chine, 75020 Paris, France
| | - Nathalie Chabbert-Buffet
- INSERM UMRS 938, Sorbonne Université, Site Saint-Antoine, 27 rue Chaligny, CEDEX 12, 75571 Paris, France; (M.S.); (G.C.); (M.K.); (S.A.); (E.D.); (N.C.-B.)
- Service de Gynécologie Sestertius et Médecine de la Reproduction, AP-HP Sorbonne Université Site Tenon, 4 rue de la Chine, 75020 Paris, France
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Jha S, Ahmed N, Sinha HH. Safety and efficacy of two repeated cycles of ulipristal acetate in the management of symptomatic uterine fibroid among Indian women. Prz Menopauzalny 2021; 20:127-132. [PMID: 34703413 PMCID: PMC8525252 DOI: 10.5114/pm.2021.109509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/22/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION To evaluate the safety and efficacy along with the impact on uterine and fibroid vascular indices of 2 repeat 12-week courses of ulipristal acetate (UPA) among Indian women. MATERIAL AND METHODS Ninety-four premenopausal women aged 18-45 years with at least 1 symptomatic fibroid of size ranging from 1 cm to 10 cm were included in the study. All participants received 2 courses of 5 mg of UPA orally for 12 weeks starting from the 5th day of their menstrual cycle with a 2-menstrual-cycle break in between. The efficacy was measured in terms of time to amenorrhoea, percentage of women who achieved amenorrhoea for the last 35 consecutive days, reduction in uterine and fibroid volume, as well as its vascularity at the end of the first and second treatment cycle. RESULTS Eighty-six women completed the first treatment cycle whereas only 65 women completed the second treatment course. Seventy-nine per cent of women achieved amenorrhoea for 35 consecutive days during the first treatment cycle. Median time to amenorrhoea was 7 days and 5 days during the first and second treatment cycle, respectively. Percentage reduction of the mean fibroid volume was 32% and 52% after the first and second treatment cycle, respectively. We observed an increase in fibroid vascular indices (pulsatility index and resistive index) suggesting reduction in fibroid vascularity. Serum oestradiol remained at mid-follicular phase. No serious drug emergent side effect was noted. CONCLUSIONS Two interrupted repeat course of 5mg UPA is well tolerated efficient and safe in symptomatic fibroid among Indian women.
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Affiliation(s)
- Sangam Jha
- All India Institute of Medical Sciences, Patna, India
| | - Naaz Ahmed
- All India Institute of Medical Sciences, Patna, India
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Nicolás I, Martínez-Zamora MÁ, Gracia M, Carrion A, Feixas G, Bernal L, Quintas L, Rius M, Castelo-Branco C, Carmona F. Management of symptomatic uterine fibroids after ulipristal acetate suspension and identification of high risk patients for surgery at 6-months of follow-up. Gynecol Endocrinol 2021; 37:831-835. [PMID: 34044726 DOI: 10.1080/09513590.2021.1929152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The use of ulipristal acetate (UPA) was indicated for the treatment of uterine fibroids. Following UPA suspension in March 2020, some patients presented worsening and required surgery. We aimed to identify patients at high-risk for undergoing surgery after UPA suspension. METHODS We evaluated 85 women receiving intermittent UPA treatment until March 2020. Following UPA suspension, patients received other medical treatments or surgery. The clinico-pathological features were recoded and a quality of life health survey was completed by patients at the time of UPA suspension and at 6-months thereafter. RESULTS After the suspension of UPA, 17 of the 85 patients receiving intermittent UPA (20%) required surgery, and 68 (80%) required other medical treatments. Patients who underwent surgery were younger and had greater fibroid volume. CONCLUSIONS In our series, 20% of clinically stable patients receiving intermittent UPA required surgery following UPA suspension. These women should be considered for future medical strategies.
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Affiliation(s)
- Inmaculada Nicolás
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - María Ángeles Martínez-Zamora
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ana Carrion
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Georgina Feixas
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Laura Bernal
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Lara Quintas
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Mariona Rius
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Camil Castelo-Branco
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Szydłowska I, Grabowska M, Nawrocka-Rutkowska J, Kram A, Piasecka M, Starczewski A. Markers of Inflammation and Vascular Parameters in Selective Progesterone Receptor Modulator ( Ulipristal Acetate)-Treated Uterine Fibroids. J Clin Med 2021; 10:jcm10163721. [PMID: 34442017 PMCID: PMC8397116 DOI: 10.3390/jcm10163721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 01/17/2023] Open
Abstract
The exact mechanism of selective progesterone receptor modulator action in leiomyoma still challenges researchers. The aim of the study was to assess the effects of ulipristal acetate (UPA) on immunoexpression of inflammatory markers and vascularization in fibroids. UPA-treated patients were divided into three groups: (1) good response (≥25% reduction in volume of fibroid), (2) weak response (insignificant volume reduction), (3) and no response to treatment (no decrease or increase in fibroid volume). The percentage of TGFβ, IL6, IL10, CD117, and CD68-positive cells were significantly lower in the group with a good response to treatment vs. the control group. Moreover, the percentage of IL10 and CD68-positive cells in the group with a good response to treatment were also significantly lower compared to the no response group. Additionally, a significant decrease in the percentage of IL10-positive cells was found in the good response group vs. the weak response group. There were no statistical differences in the percentage of TNFα-positive cells and vessel parameters between all compared groups. The results of the study indicate that a good response to UPA treatment may be associated with a decrease of inflammatory markers, but it does not influence myoma vascularization.
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Affiliation(s)
- Iwona Szydłowska
- Department of Gynecology, Endocrinology and Gynecological Oncology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1 Street, 71-252 Szczecin, Poland; (J.N.-R.); (A.S.)
- Correspondence: (I.S.); (M.G.); Tel.: +48-91-425-0541 (I.S.)
| | - Marta Grabowska
- Department of Histology and Developmental Biology, Pomeranian Medical University, Żołnierska 48 Street, 71-210 Szczecin, Poland;
- Correspondence: (I.S.); (M.G.); Tel.: +48-91-425-0541 (I.S.)
| | - Jolanta Nawrocka-Rutkowska
- Department of Gynecology, Endocrinology and Gynecological Oncology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1 Street, 71-252 Szczecin, Poland; (J.N.-R.); (A.S.)
| | - Andrzej Kram
- Department of Pathology, West Pomeranian Oncology Center, Strzałowska 22 Street, 71-730 Szczecin, Poland;
| | - Małgorzata Piasecka
- Department of Histology and Developmental Biology, Pomeranian Medical University, Żołnierska 48 Street, 71-210 Szczecin, Poland;
| | - Andrzej Starczewski
- Department of Gynecology, Endocrinology and Gynecological Oncology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1 Street, 71-252 Szczecin, Poland; (J.N.-R.); (A.S.)
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Panda S, Das R, Das A, Sharma N, Sharma A. A study to assess the knowledge and awareness among young doctors about emergency contraception. J Family Med Prim Care 2021; 10:2304-2312. [PMID: 34322429 PMCID: PMC8284221 DOI: 10.4103/jfmpc.jfmpc_2439_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/21/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Emergency contraception (EC) is the contraception on demand which can prevent millions of unintended pregnancies. The knowledge and awareness of young doctors towards EC who may be the first contact physician of the society has not been well studied. This study aims to assess the knowledge and awareness of young doctors in a teaching institute in northeast India. Methodology: This study was carried out among 200 young doctors and included 100 interns and 100 postgraduate trainees (PGT) and senior resident doctors (SRD) from January 2020 to March 2020 to compare their knowledge and awareness about EC. A predesigned self-administered 22 items questionnaire was used to collect data. Observation: In our study, majority of the doctors in both groups were aware of levonorgestrel 1.5 mg tablet as EC (93% and 95%) and more interns than PG SRD were aware of its easy availability (86%, 35%, P value < 0.0001), government supply (77%, 30%, P value < 0.0001), and that copper intrauterine contraceptive device (IUCD) can be used as EC up to 120 h (89%, 60%, P value < 0.0001). Most doctors were unaware of ulipristal acetate. Most PGT SRDs believe that EC promotes irresponsible behavior, sexually transmitted diseases, and promiscuity but most intern did not agree to it (P value < 0.0001 for each). More than 65% doctors in both groups were aware of the mechanism of action of EC. PGT SRD were more aware of the effectiveness of EC (62%, 80%, P value 0.0078). More interns were aware that EC affects the next period (53%, 25%, P value < 0.0001). Conclusion: Interns were more aware about contraception than PGT and SRD, especially about government supply of EC, about IUCD, and behavioral aspect like promoting irresponsible behavior, sexually transmitted disease, and promiscuity.
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Affiliation(s)
- Subrat Panda
- Department of Obstetrics & Gynaecology, NEIGRIHMS, Meghalaya, India
| | - Rituparna Das
- Department of Obstetrics & Gynaecology, NEIGRIHMS, Meghalaya, India
| | - Ananya Das
- Department of Obstetrics & Gynaecology, NEIGRIHMS, Meghalaya, India
| | - Nalini Sharma
- Department of Obstetrics & Gynaecology, NEIGRIHMS, Meghalaya, India
| | - Anusuya Sharma
- Department of Obstetrics & Gynaecology, NEIGRIHMS, Meghalaya, India
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Kunow C, Bello MA, Diedrich L, Eutin L, Sonnenberg Y, Wachtel N, Langer B. A Nationwide Mystery Caller Evaluation of Oral Emergency Contraception Practices from German Community Pharmacies: An Observational Study Protocol. Healthcare (Basel) 2021; 9:945. [PMID: 34442082 DOI: 10.3390/healthcare9080945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/04/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022] Open
Abstract
To prevent unwanted pregnancies, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is recommended by the guidelines of the German Federal Chamber of Pharmacists (BAK). In this respect, community pharmacies (CPs) in Germany have a major responsibility for information gathering, selecting the appropriate medicine, availability and pricing, among other things. Therefore, it would be appropriate to conduct a study with the aim of investigating information gathering, a possible recommendation as well as availability and pricing for oral EC in German CPs. A representative nationwide observational study based on the simulated patient methodology (SPM) in the form of covert mystery calls will be conducted in a random sample of German CPs stratified according to the 16 federal states. Each selected CP will be randomly called once successfully by one of six both female and male trained mystery callers (MCs). The MCs will simulate a product-based scenario using the request for oral EC. For quality assurance of the data collection, a second observer accompanying the MC is planned. After all mystery calls have been made, each CP will receive written, pharmacy-specific performance feedback. The only national SPM study on oral EC to date has identified deficits in the provision of self-medication consultations with the help of visits in the CPs studied. International studies suggest that UPA in particular is not always available. Significant price differences could be found analogous to another German study for a different indication.
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Dinis-Oliveira RJ, Vieira DN. Acute liver failure requiring transplantation: A possible link to ulipristal acetate treatment? Basic Clin Pharmacol Toxicol 2021; 129:278-282. [PMID: 34187080 DOI: 10.1111/bcpt.13631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022]
Abstract
The present case describes in detail a 55-year-old woman diagnosed with acute liver injury 3 days after completion of the first treatment course with ulipristal acetate (UPA), 5 mg/day orally for uterine fibroids causing persistent bleeding (treatment duration of 109 days). Liver transplantation was performed approximately 6 weeks after UPA suspension, and a photograph of the explanted liver is presented. Of note, other common causes of acute liver injury, such as history of alcohol or other psychoactive substances abuse, viral hepatitis and autoimmune hepatitis or preexisting liver disease were all excluded. This case was reported to the European Medicines Agency (EMA) and contributed to the final recommendations of the Pharmacovigilance Risk Assessment Committee (PRAC) disclosed in January 2021. The causality assessment considered a probable case of drug-induced liver injury as a consequence of UPA treatment, and the Roussel Uclaf Causality Assessment Method (RUCAM) was scored as unlikely. Although further studies are needed aiming to avoid confounding factors, this case suggests that liver function tests should be monitored during treatment with UPA.
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Affiliation(s)
- Ricardo Jorge Dinis-Oliveira
- TOXRUN - Toxicology Research Unit, University Institute of Health Sciences, Advanced Polytechnic and University Cooperative (CESPU), CRL, Gandra, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.,UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Jambrina AM, Rius P, Gascón P, Armelles M, Camps-Bossacoma M, Franch À, Rabanal M. Characterization of the Use of Emergency Contraception from Sentinel Pharmacies in a Region of Southern Europe. J Clin Med 2021; 10:jcm10132793. [PMID: 34201980 PMCID: PMC8269101 DOI: 10.3390/jcm10132793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022] Open
Abstract
Numerous studies have been published suggesting that emergency contraception (EC) is used repeatedly, but a lack of information regarding the profile of users makes it difficult to evaluate actual consumer habits. The aim of this study was to obtain information regarding the profile of users who obtain EC and other factors that might play a role, and to provide criteria to evaluate and improve the strategies of current contraceptive programs. This was an observational one-year study based on surveillance data on the provision of EC to women of reproductive age in 60 community pharmacies in Catalonia, Spain. In total, 941 notifications of dispensation of EC in Catalonia were received. A total of 44.2% of users said it was not the first time that they had taken the medication (repeat user). The percentage of users who used condoms was lower in repeat users compared to first-time users (56.7% vs. 64.4%, p < 0.05). A total of 25.7% of users stated that they did not use any barrier contraceptive method. The use of natural methods in repeat users was 53.8% in the subgroup who requested the medication after 48 h, significantly higher than in users who obtained the medication within the first 24 h (p < 0.05). A high percentage of repeat users with risky sexual behaviors were detected, suggesting that new measures must be implemented to provide information for this method, together with educational and preventive strategies.
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Affiliation(s)
- Anna M. Jambrina
- Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, 08028 Barcelona, Spain; (A.M.J.); (M.A.)
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (M.C.-B.); (À.F.)
| | - Pilar Rius
- Council of the Pharmacist’s Association of Catalonia, 08009 Barcelona, Spain;
| | - Pilar Gascón
- Blanquerna School of Health Sciences, Ramon Llull University, 08022 Barcelona, Spain;
| | - Mercè Armelles
- Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, 08028 Barcelona, Spain; (A.M.J.); (M.A.)
| | - Mariona Camps-Bossacoma
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (M.C.-B.); (À.F.)
| | - Àngels Franch
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (M.C.-B.); (À.F.)
| | - Manel Rabanal
- Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, 08028 Barcelona, Spain; (A.M.J.); (M.A.)
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (M.C.-B.); (À.F.)
- Correspondence:
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Salas A, Vázquez P, Bello AR, Báez D, Almeida TA. Dual agonist-antagonist effect of ulipristal acetate in human endometrium and myometrium. Expert Rev Mol Diagn 2021; 21:851-857. [PMID: 34110938 DOI: 10.1080/14737159.2021.1941878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to assess the molecular effect of ulipristal acetate (UPA) on gene expression in myometrium and endometrium of patients with symptomatic fibroids. Tissues isolated from four women treated preoperatively with UPA (5 mg) were compared to those from untreated controls using NanoString platform to assess the expression of 75 candidate genes modulated by UPA and ovarian steroids. Deregulated genes were then validated by real-time PCR. In myometrium, UPA exerted an antagonistic effect similar to that observed in fibroids. In UPA-treated endometrium, six genes were identified as highly and significantly upregulated, including matricellular genes CCN1 (54-fold, P = 0.0018) and CCN2 (11-fold, P = 0.00044), Krüppel-like factor 4 (>3-fold, P = 0.0036), and mast cell markers including tryptases TPSAB1/TPSB2 (31-fold, P = 0.023) and carboxypeptidase A (CPA3, 17-fold, P = 0.05). In endometrium, UPA induced the expression of genes involved in fibrogenesis and mast cell function-some of them being widely involved in hepatic injury, which could explain the marked fibrosis and inflammatory cell infiltration observed in explanted livers from patients under UPA treatment.
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Affiliation(s)
- Ana Salas
- Departamento de Bioquímica, Microbiología, Biología Celular Y Genética, Universidad de La Laguna. Facultad De Ciencias. Sección de Biología, Tenerife, Spain.,Instituto de Enfermedades Tropicales y Salud Pública de Canarias (IUETSPC). Avda. Astrofísico Fco. Sánchez S/n. 38200. San Cristóbal de La Laguna, Tenerife, Spain
| | - Paula Vázquez
- Departamento de Bioquímica, Microbiología, Biología Celular Y Genética, Universidad de La Laguna. Facultad De Ciencias. Sección de Biología, Tenerife, Spain
| | - Aixa R Bello
- Departamento de Bioquímica, Microbiología, Biología Celular Y Genética, Universidad de La Laguna. Facultad De Ciencias. Sección de Biología, Tenerife, Spain.,Instituto de Enfermedades Tropicales y Salud Pública de Canarias (IUETSPC). Avda. Astrofísico Fco. Sánchez S/n. 38200. San Cristóbal de La Laguna, Tenerife, Spain
| | - Delia Báez
- Departamento de Obstetricia y Ginecología, Facultad de Ciencias de La Salud, Universidad de La Laguna, Campus de Ofra S/n, Tenerife, Spain
| | - Teresa A Almeida
- Departamento de Bioquímica, Microbiología, Biología Celular Y Genética, Universidad de La Laguna. Facultad De Ciencias. Sección de Biología, Tenerife, Spain.,Instituto de Enfermedades Tropicales y Salud Pública de Canarias (IUETSPC). Avda. Astrofísico Fco. Sánchez S/n. 38200. San Cristóbal de La Laguna, Tenerife, Spain
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Osuga Y, Nakano Y, Yamauchi Y, Murakawa H. Phase III long-term study to evaluate the efficacy and safety of ulipristal acetate in Japanese patients with uterine fibroids. J Obstet Gynaecol Res 2021; 47:3269-3278. [PMID: 34109697 PMCID: PMC8453825 DOI: 10.1111/jog.14802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/14/2021] [Accepted: 04/10/2021] [Indexed: 11/29/2022]
Abstract
Aim To assess the efficacy and safety of long‐term intermittent administration of 10‐mg ulipristal acetate (UPA) for symptomatic uterine fibroids in Japanese women. Methods Open‐label, noncomparative study (Japan Primary Registries Network identifier: JapicCTI‐173737) conducted at 32 gynecological centers (November 2017–December 2019). Premenopausal women diagnosed with uterine fibroids associated with heavy menstrual bleeding received three 12‐week courses of 10‐mg UPA once daily. Amenorrhea, fibroid volume, endometrial histology, and safety were assessed. Results Of 155 patients enrolled, 140 received ≥1 dose of UPA and were analyzed. Across all courses, the rates of patients with amenorrhea for 35 days were >90%, and >99% of patients achieved uterine bleeding normalization. Median time to amenorrhea after each course started was 4–5 days; menstruation returned after treatment within a median of 25–27 days. Mean changes in fibroid volume from baseline were −21.5%, −31.4%, and −35.0% for Courses 1, 2, and 3, respectively. Patients experienced sustained improvements in anemia, pain, and quality of life during treatment. Most adverse events were mild/moderate in severity and decreased in frequency with each course. Seven serious adverse events (six patients) were reported; anemia, embolic cerebral infarction, and pituitary apoplexy (one patient each) were considered UPA‐related. Nonphysiological changes in endometrial histology were transient and benign. No safety concerns were detected in hormone concentrations or liver function tests. Conclusions Long‐term administration of 10‐mg UPA is effective for reducing symptoms associated with uterine fibroids in Japanese women. UPA was well tolerated and few safety concerns were reported.
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Affiliation(s)
- Yutaka Osuga
- Department of Gynecologic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasuaki Nakano
- Clinical Development Department, ASKA Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Yuji Yamauchi
- Clinical Development Department, ASKA Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Hitoshi Murakawa
- Clinical Development Department, ASKA Pharmaceutical Co., Ltd., Tokyo, Japan
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23
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Abstract
CONTEXT Large-scale clinical trials on the hepatotoxicity of ulipristal acetate (UPA) are lacking. OBJECTIVE This work aimed to determine the incidence of liver disease with UPA vs gonadotropin-releasing hormone (GnRH) agonists. METHODS A retrospective cohort study was conducted in South Korea of women with uterine fibroids from the Korean Health Insurance Data 2010 to 2018. Women with uterine fibroids were divided into 2 treatment groups: the UPA (5 mg/day) and GnRH agonist groups. Main outcome measures included the presence or absence of severe liver disease, mild liver disease, and liver transplantation. RESULTS Among the patients with uterine fibroids,17 207 patients were treated with GnRH agonists and 20 926 patients with UPA. After 1:1 propensity score matching for each group, there were 11 445 individuals. Neither group had a liver transplantation case. In the conditional logistic regression analysis, the incidence of total liver diseases (relative risk [RR] 1.111; 95% CI, 1.015-1.216) and mild liver diseases (RR 1.094; 95% CI, 1-1.196) was higher in the UPA group than in the GnRH agonist group, but that of severe liver diseases (RR 0.07; 95% CI, 0.001-4.412) and toxic liver disease (RR 1.256; 95% CI, 0.845-1.867) did not differ between the groups. CONCLUSION The incidence of severe liver disease, hepatic failure, and toxic liver disease was not different between the UPA and GnRH agonist groups. However, the incidence of mild liver disease was higher in the UPA group than in the GnRH agonist group. The incidence of hepatic damage with UPA was very low.
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Affiliation(s)
- Eileen L Yoon
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Nowon-gu, Seoul 01757, Republic of Korea
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Baser E, Aydogan Kirmizi D, Kasapoglu T, Fırtına Tuncer S, Ozturk Başarir Z, Salgur F, Bilge M, Altinbas SK, Tapisiz OL. Unplanned pregnancy and awareness of emergency contraception: a postpartum period survey. EUR J CONTRACEP REPR 2021; 26:507-512. [PMID: 33855927 DOI: 10.1080/13625187.2021.1906411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The study aimed to determine the awareness of emergency contraception (EC) and knowledge of its use as well as the unplanned pregnancy rate among women in the immediate postpartum period in Ankara, Turkey's second largest city. METHODS Interviews were carried out among 1955 women on their first or second day postpartum. The interview was based on a questionnaire containing 19 questions covering participants' awareness and experience of using EC as well as their future approach to its use. RESULTS The rate of unplanned pregnancy was 18.2% and the rate of EC awareness was 26.0%; 89.4% of those who were aware of EC knew how to use it correctly. In the multivariate regression analysis, employment, household income and level of education were independently associated with EC awareness; gravidity, household income, level of education and number of abortions were independently associated with unplanned pregnancy. Awareness of EC increased significantly (p < .05) with age, household income and educational level; knowledge about the correct use of EC increased with age and educational level (p < .05). CONCLUSION EC awareness among the study population was low and was related to household income and educational level. Household income, educational level and gravidity were the most important factors associated with unplanned pregnancy. Governments must therefore establish appropriate health policies and provide contraceptive education to women from adolescence onwards.
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Affiliation(s)
- Emre Baser
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Demet Aydogan Kirmizi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Taner Kasapoglu
- Department of Obstetrics and Gynaecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Serap Fırtına Tuncer
- Department of Obstetrics and Gynaecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Zehra Ozturk Başarir
- Department of Gynaecologic Oncology, Ankara Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey
| | - Funda Salgur
- Department of Family Medicine, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Melek Bilge
- Department of Obstetrics, Dr Ali Kemal Belviranli Hospital for Obstetrics and Paediatrics, Konya, Turkey
| | - Sadiman Kiykac Altinbas
- Department of Obstetrics and Gynaecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Omer Lutfi Tapisiz
- Department of Obstetrics and Gynaecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
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Chodankar RR, Murray A, Nicol M, Whitaker LHR, Williams ARW, Critchley HOD. The endometrial response to modulation of ligand-progesterone receptor pathways is reversible. Fertil Steril 2021; 116:882-895. [PMID: 33865567 DOI: 10.1016/j.fertnstert.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To study the impact of the progesterone receptor modulator (PRM), ulipristal acetate (UPA), on endometrial morphology and function. DESIGN Cross-sectional. SETTING University Research Institute. PATIENT(S) Endometrial biopsies from 16 patients with heavy menstrual bleeding with a structurally normal uterus or in association with structural abnormalities identified on radiological imaging (fibroids, adenomyosis or a combination of fibroids and adenomyosis). INTERVENTION(S) Participants received UPA (5 mg once daily) for three 12-week courses, each separated by 4 weeks without treatment. MAIN OUTCOME MEASURE(S) Gene expression by real-time quantitative reverse transcription polymerase chain reaction, immunohistochemistry, and digital image analysis were analyzed to investigate the endometrial impact of modulation of progesterone receptor pathways upon expression of steroid receptors, steroid metabolizing enzymes, cell proliferation, and progesterone-regulated genes in the same patients at 3 time points: before, during, and after discontinuation of PRM treatment. RESULT(S) Ulipristal acetate treatment resulted in increased messenger ribonucleic acid (mRNA) levels of steroid receptors compared with pretreatment secretory endometrium; decreased mRNA levels of 17- and 11-beta-hydroxysteroid dehydrogenases compared with pretreatment proliferative endometrium and pretreatment secretory endometrium; reduced cell proliferation compared with pretreatment proliferative endometrium; and altered mRNA levels of progesterone-regulated genes. A strong consistency between immunohistochemistry-digital image analysis and real-time quantitative reverse transcription polymerase chain reaction results was evident. Alterations in the mRNA levels and endometrial morphology returned to a pretreatment phenotype after the cessation of PRM exposure. CONCLUSION(S) The endometrial impact of the modulation of progesterone receptor pathways with PRM (UPA) treatment is reversible. CLINICAL TRIAL REGISTRATION NUMBER Ulipristal acetate versus conventional management of heavy menstrual bleeding (UCON) trial (EudraCT 2014-003408-65; REC14/LO/1602).
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Affiliation(s)
- Rohan R Chodankar
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Alison Murray
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Moira Nicol
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Lucy H R Whitaker
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Alistair R W Williams
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Hilary O D Critchley
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, United Kingdom.
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26
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Tinelli A, Gustapane S, D'Oria O, Licchelli M, Panese G. Nutraceuticals in fibroid management after ulipristal acetate administration: An observational study on patients' compliance. Int J Gynaecol Obstet 2021; 156:133-138. [PMID: 33797759 DOI: 10.1002/ijgo.13692] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/18/2021] [Accepted: 03/31/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE On May 13, 2020, the Italian government Pharmaceutical Agency (AIFA) stopped ulipristal acetate (UPA) treatments for uterine fibroids (UFs), so patients shifted to other natural treatments. The authors tested the patients' compliance with UF natural treatments. METHODS Thirty patients of reproductive age (30-45 years) affected by UFs stopped UPA intake and started epigallocatechin gallate (EGCG) plus vitamin D3 treatment. Patients were asked to complete the Uterine Fibroid symptoms and Quality of Life (UFS-QOL) questionnaire, divided into symptoms severity (SS) and health-related quality of life (HRQL), after UPA suspension and to repeat it after 3 months of natural treatment. Collected data were analyzed using paired Student's t test, considering a P value less than 0.05 to be significant. RESULTS The SS score was significantly lower (-12.19%) for natural treatment when compared with UPA administration. The HRQL score significantly improved (+11.79%) after shifting treatment from UPA to natural therapy. All the investigated parameters appeared improved by 10% after the natural treatment. No adverse effects were reported following the natural treatment. CONCLUSION Natural treatments showed positive compliance in patients with UFs, based on HRQL score, representing an alternative therapeutic opportunity for patients forced to stop UPA therapy.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics & Gynecology, "Veris delli Ponti Hospital", Scorrano (Le), Italy.,CERICSAL (CEntro di RIcerca Clinico SALentino, "Veris delli Ponti Hospital", Scorrano (Le), Italy.,Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, Lecce, Italy.,Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia
| | - Sarah Gustapane
- Department of Obstetrics & Gynecology, "Veris delli Ponti Hospital", Scorrano (Le), Italy
| | - Ottavia D'Oria
- Department of Obstetrics & Gynecology, "Veris delli Ponti Hospital", Scorrano (Le), Italy
| | - Martina Licchelli
- Department of Obstetrics & Gynecology, "Veris delli Ponti Hospital", Scorrano (Le), Italy
| | - Gaetano Panese
- Department of Obstetrics & Gynecology, "Veris delli Ponti Hospital", Scorrano (Le), Italy
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Osuga Y, Nakano Y, Yamauchi Y, Takanashi M. Ulipristal acetate compared with leuprorelin acetate for Japanese women with symptomatic uterine fibroids: a phase III randomized controlled trial. Fertil Steril 2021; 116:189-197. [PMID: 33715871 DOI: 10.1016/j.fertnstert.2021.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of ulipristal acetate (UPA) for uterine fibroids (UFs), a phase III study was conducted with leuprorelin (LEU) as a comparator. This is the first confirmatory trial of UPA for UFs among Asians. DESIGN Multicenter, randomized, double-blind, double-dummy, parallel-group study. SETTING Thirty-two sites in Japan. PATIENT(S) Patients were assigned to 2 arms, with 82 patients in the UPA group and 79 patients in the LEU group. INTERVENTION(S) In the UPA group, 10 mg of UPA was orally administered once a day for 12 weeks. In the LEU group, 1.88 mg or 3.75 mg of LEU was subcutaneously administered at weeks 0, 4, and 8. MAIN OUTCOME MEASURE(S) The primary endpoint was the percentage of patients with amenorrhea for 35 days. For safety evaluation, adverse events (AEs) were recorded. RESULT(S) The percentage of patients with amenorrhea for 35 days was 87.0% in the UPA group and 81.8% in the LEU group, and the efficacy of UPA for causing amenorrhea for 35 days was confirmed to be noninferior to that of LEU. AEs occurred in 78.0% of the patients in the UPA group and 88.8% of the patients in the LEU group. CONCLUSION(S) The effect of UPA on heavy menstrual bleeding was shown to be comparable with that of LEU in Japanese patients with symptomatic UFs. No notable AEs occurred because of the UPA treatment, and the incidence of AEs in the UPA group was comparable with that of AEs in the LEU group. This result demonstrates the clinical utility of UPA for Asians.
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Affiliation(s)
- Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Abstract
OBJECTIVES The increasing availability of health information online combined with reduced access to health care providers due to the coronavirus pandemic means that more people are using the internet for health information. However, with no standardised regulation of the internet, the population is vulnerable to misinformation regarding important health information. This review aimed to evaluate the quality and readability of the online information available on emergency contraception (EC) options. STUDY DESIGN In this descriptive study, a Google search was performed using the term 'emergency contraception options' on 13 April 2020 yielding 232 results. Seventy-one results were excluded (34 inaccessible, 37 contained no medical information). The remaining 161 results were categorised by typology and assessed for credibility (JAMA criteria and HONcode), reliability (DISCERN tool) and readability (Flesch-Kincaid Grade Level and Simple Measure of Gobbledygook). RESULTS Of all webpages evaluated, the most common typology was governmental. Credibility of web pages was poor (average JAMA score of 1.47 out of 4). Only 10.6% of webpages were HONcode certified. The most common DISCERN category was Fair (29.81%), closely followed by Poor (27.95%) reliability. On average, readability levels were above the recommended grade level for health information. The intrauterine device was discussed least frequently (86.96%) of all the EC options. CONCLUSION Online information was of low credibility, reliability and written above the recommended reading level. Clinicians should be aware of the poor quality of online information on EC options, and actively educate patients on what makes a source credible.
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Affiliation(s)
- Simrita Agrawal
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ciara Irwin
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rima K Dhillon-Smith
- Birmingham Women's Hospital Academic Department, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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29
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Szydłowska I, Grabowska M, Nawrocka-Rutkowska J, Piasecka M, Starczewski A. Markers of Cellular Proliferation, Apoptosis, Estrogen/Progesterone Receptor Expression and Fibrosis in Selective Progesterone Receptor Modulator ( Ulipristal Acetate)-Treated Uterine Fibroids. J Clin Med 2021; 10:562. [PMID: 33546154 DOI: 10.3390/jcm10040562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022] Open
Abstract
There appear to be very few data on the exact mechanisms of a selective progesterone receptor modulator action in myomas. The aim of the study was to assess the effects of ulipristal acetate (UPA) on fibroids, especially on estrogen receptor (ER) and progesterone receptor (PR) immunoexpression, proliferation, apoptosis and tissue fibrosis, and to compare the above parameters in untreated (surgical attention only) and UPA-treated leiomyomas. UPA-treated patients were divided into three groups: (1) good response (≥25% reduction in volume of fibroid), (2) weak response (insignificant volume reduction) and (3) no response to treatment (no decrease or increase in fibroid volume). The study observed a significant decrease in the percentage of collagen volume fraction and ER and PR immunoexpression in the good response group, in the percentage of proliferating cell nuclear antigen (PCNA)- and Ki67-positive cells in the groups with good and weak reactions vs. control group; significantly higher apoptotic index (terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL)-positive cells) in the good reaction group vs. control group. The results of the study indicate that a good response to UPA, manifested by a volume reduction of myoma, may be associated with a decrease in fibrosis, ER/PR and PCNA and Ki67 immunoexpression and an increase in cell apoptosis within the myoma.
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30
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Middelkoop MA, Bet PM, Drenth JPH, Huirne JAF, Hehenkamp WJK. Risk-efficacy balance of ulipristal acetate compared to surgical alternatives. Br J Clin Pharmacol 2021; 87:2685-2697. [PMID: 33341097 PMCID: PMC8359338 DOI: 10.1111/bcp.14708] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/26/2020] [Accepted: 12/07/2020] [Indexed: 01/12/2023] Open
Abstract
Aims Uterine fibroids are benign tumours that cause various complaints. These complaints may significantly compromise quality of life, necessitating a clinical intervention in 25–50% of the affected women. Hysterectomy, myomectomy or embolization may offer symptomatic relief, but are costly, include a recovery period, can cause serious side‐effects, sometimes fail to treat symptoms completely and are not always desired by patients. Ulipristal is a conservative long‐term treatment that has a fibroid‐volume decreasing effect, acceptable side‐effects while preserving fertility and may be an alternative to surgical alternatives. Currently, ulipristal is investigated by the European Medicine Agency and suspended from marketing authorization because it may cause drug‐induced liver injury (DILI). However, many drugs can cause severe DILI and prospective studies estimate 14–19 DILI cases/100 000 people. Methods This overview will discuss the risk–benefit balance between ulipristal and DILI, describe the safety–efficacy balance of ulipristal and its alternative treatments and the arguments that led to the suspension of its marketing authorization. Results Ulipristal may be associated with DILI resulting in a risk of severe liver injury in 1.5:100 000 patients and fatal liver injury in 0.1:100 000 patients. This risk needs to be weighed against the higher mortality risk of >1:1000 and higher incidence of severe complications after surgery. Conclusion The DILI risk of ulipristal is considerably lower than that of other medicines that are not suspended, nor need additional safety measures. When evaluating drugs and drug safety, risks that apply to the alternative nonpharmacological treatment options should be taken into consideration.
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Affiliation(s)
- Mei-An Middelkoop
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development research institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology, Radboud UMC, Nijmegen, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development research institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development research institute, Amsterdam UMC, Amsterdam, The Netherlands
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Abstract
Uterine fibroids (leiomyomas or myomas) are the most frequent benign tumors in women. Heavy menstrual bleeding with resultant anemia, dysmenorrhea, chronic pelvic pain, infertility urinary symptoms and constipation are generally associated with uterine fibroids (UFs). Although strategies mainly resort to surgical intervention, medical treatments are considered the first-line treatment to preserve fertility and avoid surgery. The aim of this review is to offer available and newest medical treatment options for symptomatic UFs. Various medical therapies are now available for women with uterine fibroids, although each therapy has its own advantages and disadvantages. Our topic specifically explores gonadotropin-releasing hormone (GnRH) analogs and selective progesterone receptor modulators (SPRMs), but also provides the reader with useful advice on the therapies for fibroids available after the recent European Medicines Agency (EMA) warning (EMA/160220/2020). The treatment options depend on the personal treatment objectives of the patients, in addition to treatment effectiveness and necessity for recurrent interventions.
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Affiliation(s)
- Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari. Italy
| | - Maurizio N D'Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari. Italy
| | - Angelos Daniilidis
- Second Department of Obstetrics and Gynecology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki,. Greece
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De Franciscis P, Schiattarella A, Riemma G, Labriola D, Ambrosio D, Vitale SG, Cianci A, Cucinella G, Calagna G, Colacurci N. Hysteroscopic and ultrasonographic evaluation of ulipristal acetate treatment for symptomatic myomas in premenopausal women: a prospective study. MINIM INVASIV THER 2020; 31:435-440. [PMID: 33043778 DOI: 10.1080/13645706.2020.1829648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to analyze the effects of a six-month therapy with ulipristal acetate (UPA) on myoma size and endometrial thickness in premenopausal women. MATERIAL AND METHODS Seventy-four women undergoing conservative therapy with UPA were enrolled for this study. All women underwent transvaginal ultrasound evaluation to assess the endometrial thickness, and the number and size of myomas at the beginning and after six months. Hysteroscopy and biopsy were performed after six months, if necessary. RESULTS After six months of treatment, sonographic examination showed a statistically significant (p < .05) reduction of the size of the largest myoma (56.3 ± 5.1 vs. 31.7 ± 10.1 mm) and a statistically significant (p < .05) increase in endometrial thickness (5.9 ± 2.1 vs. 9.7 ± 3.4 mm). Twenty-two patients with endometrial thickness >10 mm or nonhomogeneous pattern and ten patients with metrorrhagia underwent hysteroscopy: the most frequent finding was the combination of endometrial hypotrophy, floating surface, and chicken-wire vascular pattern aspect (14 cases, 43.7%). Histologic findings showed no case of complex hyperplasia. CONCLUSION UPA is a safe, effective and assured method to decrease symptoms, reduce the need for surgery in premenopausal women suitable for the treatment.
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Affiliation(s)
- Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Domenico Labriola
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Domenico Ambrosio
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Antonio Cianci
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Gaspare Cucinella
- Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy
| | - Gloria Calagna
- Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Abstract
Selective progesterone receptor modulators (SPRMs) are a new class of compounds developed to target the progesterone receptor (PR) with a mix of agonist and antagonist properties. These compounds have been introduced for the treatment of several gynecological conditions based on the critical role of progesterone in reproduction and reproductive tissues. In patients with uterine fibroids, mifepristone and ulipristal acetate have consistently demonstrated efficacy, and vilaprisan is currently under investigation, while studies of asoprisnil and telapristone were halted for safety concerns. Mifepristone demonstrated utility for the management of endometriosis, while data are limited regarding the efficacy of asoprisnil, ulipristal acetate, telapristone, and vilaprisan for this condition. Currently, none of the SPRMs have shown therapeutic success in treating endometrial cancer. Multiple SPRMs have been assessed for efficacy in treating PR-positive recurrent breast cancer, with in vivo studies suggesting a benefit of mifepristone, and multiple in vitro models suggesting the efficacy of ulipristal acetate and telapristone. Mifepristone, ulipristal acetate, vilaprisan, and asoprisnil effectively treated heavy menstrual bleeding (HBM) in patients with uterine fibroids, but limited data exist regarding the efficacy of SPRMs for HMB outside this context. A notable class effect of SPRMs are benign, PR modulator-associated endometrial changes (PAECs) due to the actions of the compounds on the endometrium. Both mifepristone and ulipristal acetate are effective for emergency contraception, and mifepristone was approved by the US Food and Drug Administration (FDA) in 2012 for the treatment of Cushing's syndrome due to its additional antiglucocorticoid effect. Based on current evidence, SPRMs show considerable promise for treatment of several gynecologic conditions.
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Affiliation(s)
- Md Soriful Islam
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences & Women's Health Research, Johns Hopkins Medicine, Baltimore, Maryland
| | - Sadia Afrin
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences & Women's Health Research, Johns Hopkins Medicine, Baltimore, Maryland
| | - Sara Isabel Jones
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences & Women's Health Research, Johns Hopkins Medicine, Baltimore, Maryland
| | - James Segars
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences & Women's Health Research, Johns Hopkins Medicine, Baltimore, Maryland
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Abstract
BACKGROUND Emergency contraception has been available in pharmacies across England since 2001.There is a paucity of evidence describing those women accessing the service, particularly in rural locations, where pharmacies are integral to improving healthcare accessibility. METHODS Routinely collected data from all pharmacy consultations for emergency contraception in Shropshire, England, were obtained and anonymized for the study period April 1, 2016 to January 31, 2019. Consultations were described by time, age of consultee, rationale for consultation, method dispensed (levonorgestrel or ulipristal acetate), referral for copper intrauterine device fitting, chlamydia screening where appropriate and reason for choosing pharmacy setting. Repeat attenders were also described separately. RESULTS 3499 consultations occurred during the study period; 39% were aged between 16-20 years, and 52% attended following unprotected sexual intercourse. Levonorgestrel was initially most prescribed, however ulipristal acetate overtook it in 2018. Onward referral for copper intrauterine device and age-appropriate chlamydia screening took place in 3% and 4% of the eligible populations respectively. Women overwhelmingly chose the pharmacy setting owing to its convenience. Repeat attenders tended to be younger than single attenders, but otherwise similar. CONCLUSION Pharmacy-based emergency contraception is an important and well-utilized service in this rural location and continued funding and possible service expansion should be considered.
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Affiliation(s)
- Emma Pearce
- Murray Learning Centre, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Murray Learning Centre, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Langer B, Grimm S, Lungfiel G, Mandlmeier F, Wenig V. The Quality of Counselling for Oral Emergency Contraceptive Pills-A Simulated Patient Study in German Community Pharmacies. Int J Environ Res Public Health 2020; 17:ijerph17186720. [PMID: 32942744 PMCID: PMC7559115 DOI: 10.3390/ijerph17186720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/23/2022]
Abstract
Background: In Germany, there are two different active substances, levonorgestrel (LNG) and ulipristal acetate (UPA), available as emergency contraception (the “morning after pill”) with UPA still effective even 72 to 120 h after unprotected sexual intercourse, unlike LNG. Emergency contraceptive pills have been available without a medical prescription since March 2015 but are still only dispensed by community pharmacies. The aim of this study was to determine the counselling and dispensing behaviour of pharmacy staff and the factors that may influence this behaviour in a scenario that intends that only the emergency contraceptive pill containing the active substance UPA is dispensed (appropriate outcome). Methods: A cross-sectional study was carried out in the form of a covert simulated patient study in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern and reported in accordance with the STROBE statement. Each pharmacy was visited once at random by one of four trained test buyers. They simulated a product-based request for an emergency contraceptive pill, stating contraceptive failure 3.5 days prior as the reason. The test scenario and the evaluation forms are based on the recommended actions, including the checklist from the Federal Chamber of Pharmacies. Results: All 199 planned pharmacy visits were carried out. The appropriate outcome (dispensing of UPA) was achieved in 78.9% of the test purchases (157/199). A significant correlation was identified between the use of the counselling room and the use of a checklist (p < 0.001). The use of a checklist led to a significantly higher questioning score (p < 0.001). In a multivariate binary logistic regression analysis, a higher questioning score (adjusted odds ratio [AOR] = 1.41; 95% CI = 1.22–1.63; p < 0.001) and a time between 12:01 and 4:00 p.m. (AOR = 2.54; 95% CI = 1.13–5.73; p = 0.024) compared to 8:00 to 12:00 a.m. were significantly associated with achieving the appropriate outcome. Conclusions: In a little over one-fifth of all test purchases, the required dispensing of UPA did not occur. The use of a counselling room and a checklist, the use of a checklist and the questioning score as well as the questioning score and achieving the appropriate outcome are all significantly correlated. A target regulation for the use of a counselling room, an explicit guideline recommendation about the use of a checklist, an obligation for keeping UPA in stock and appropriate mandatory continuing education programmes should be considered.
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Parikh TP, Malik M, Britten J, Aly JM, Pilgrim J, Catherino WH. Steroid hormones and hormone antagonists regulate the neural marker neurotrimin in uterine leiomyoma. Fertil Steril 2020; 113:176-186. [PMID: 32033718 DOI: 10.1016/j.fertnstert.2019.08.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/16/2019] [Accepted: 08/26/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To characterize the role of steroid hormone and antihormone exposure on neurotrimin (NTM) expression in human leiomyoma and myometrial tissue and cells. DESIGN Laboratory study of placebo and ulipristal acetate (UPA)-treated patient tissue. In vitro assessment of immortalized myometrial and leiomyoma cell lines after hormone and antihormone exposure. SETTING Academic research center. PATIENT(S) Not applicable. INTERVENTIONS(S) Exposure of leiomyoma cell lines to 17β-E2, medroxyprogesterone acetate (MPA), UPA, and fulvestrant. MAIN OUTCOME MEASURE(S) Messenger RNA expression quantified with the use of RNASeq analysis and quantitative real-time polymerase chain reaction (qRT-PCR). Protein levels quantified by means of Western blot analysis. Immunohistochemistry (IHC) on placebo- and UPA-treated patient uterine tissue specimens. RESULT(S) Expression of NTM in human uterine leiomyoma specimens according to RNASeq was increased compared with myometrium (5.22 ± 0.57-fold), which was confirmed with the use of qRT-PCR (1.95 ± 0.05). Furthermore, NTM protein was elevated in leiomyoma tissue compared with matched myometrium (2.799 ± 0.575). IHC revealed increased staining intensity in leiomyoma surgical specimens compared with matched myometrium of placebo patients. Western blot analysis in immortalized leiomyoma cell lines demonstrated an up-regulation of NTM protein expression (2.4 ± 0.04). Treatment of leiomyoma cell lines with 17β-E2 yielded a 1.98 ± 0.11-fold increase in NTM protein expression; however, treatment with fulvestrant showed no significant change compared with control. Leiomyoma cell lines demonstrated a 1.91 ± 0.97-fold increase in NTM protein expression after progesterone treatment. RNASeq analysis demonstrated a reduced expression in patient leiomyoma after UPA treatment (0.75 ± 0.14). Treatment of leiomyoma cells with UPA demonstrated a reduced total NTM protein amount (0.54 ± 0.31) in patients, which was confirmed with the use of IHC (UPA10 147.2 ± 9.40, UPA20 182.8 ± 8.98). In vitro studies with UPA treatment revealed a concentration-dependent effect that supported these findings. CONCLUSION(S) NTM, a neural cell adhesion molecule, is increased in leiomyoma compared with myometrium in patient tissue and in vitro models after estrogen and progesterone treatment. Down-regulation of expression occurs after UPA treatment, but not after fulvestrant exposure. CLINICAL TRIAL REGISTRATION NUMBER NCT00290251.
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Affiliation(s)
- Toral P Parikh
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Minnie Malik
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Joy Britten
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jasmine M Aly
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Justin Pilgrim
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - William H Catherino
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
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Del Bello B, Marcolongo P, Ciarmela P, Sorbi F, Petraglia F, Luisi S, Maellaro E. Autophagy up-regulation by ulipristal acetate as a novel target mechanism in the treatment of uterine leiomyoma: an in vitro study. Fertil Steril 2020; 112:1150-1159. [PMID: 31843092 DOI: 10.1016/j.fertnstert.2019.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/25/2019] [Accepted: 08/06/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess the effect of ulipristal acetate (UPA) on the autophagic process of uterine leiomyoma cells. DESIGN In vitro study in primary cultures of leiomyoma and myometrial cells isolated from biopsy specimen, and gene expression evaluation in biopsy material. SETTING Cellular pathology laboratory. PATIENT(S) Premenopausal women (without hormonal treatment) undergoing myomectomy or hysterectomy for symptomatic leiomyomas. INTERVENTION(S) Surgical specimens collected from uterine leiomyomas and matched normal myometria. MAIN OUTCOME MEASURE(S) After treatment of myometrial and leiomyoma cells with UPA, autophagy was evaluated by Western blot analysis of the typical biochemical markers, LC3-II, LC3-II:LC3-I ratio, and p62/SQSTM1. The expression level of Atg7 and Atg4D proteins was also assessed by Western blot. RESULT(S) The increase of LC3-II protein, LC3-II:LC3-I ratio, and p62/SQSTM1 protein indicates that UPA treatment up-regulates the autophagic response in leiomyoma cells, whereas these markers were almost unchanged in myometrial cells. Consistently, an increased level of Atg7 and Atg4D proteins was observed only in UPA-treated leiomyoma cells. The autophagic machinery is put into motion selectively in these cells, despite that the basal messenger RNA levels of LC3, SQSTM1, and ATG7 in leiomyoma biopsy specimen were not significantly different from those found in normal myometrial biopsy material. CONCLUSION(S) In vitro UPA treatment stimulates the autophagic response selectively in leiomyoma cells, which adds a novel indication for the clinical use of this selective P receptor (PR) modulator. Autophagy up-regulation may potentially contribute to the leiomyoma shrinkage occurring in UPA-treated patients and warrants further study.
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Affiliation(s)
- Barbara Del Bello
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Paola Marcolongo
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Pasquapina Ciarmela
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Flavia Sorbi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy; Unit Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - Felice Petraglia
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy; Unit Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - Stefano Luisi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy; Unit Obstetrics and Gynecology, University Hospital, Siena, Italy
| | - Emilia Maellaro
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
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Del Forno S, Degli Esposti E, Salucci P, Leonardi D, Iodice R, Arena A, Raimondo D, Paradisi R, Seracchioli R. Liver function, tolerability and satisfaction during treatment with ulipristal acetate in women with fibroids: a single center experience. Gynecol Endocrinol 2020; 36:445-447. [PMID: 31646908 DOI: 10.1080/09513590.2019.1680626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The aim of the study was to evaluate liver function in women treated with ulipristal acetate (UPA) and to assess the tolerability and satisfaction during treatment. This Cross-sectional study included women with symptomatic uterine fibroids subjected to one or more 3-month treatment courses of 5 mg UPA daily. Following European Medical Agency's prescriptions, women were asked about symptoms potentially related to liver damage and had blood tests done, to assess serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Data on side effects, tolerability and satisfaction with the therapy were obtained during a phone interview. A total of 162 women completed the study with a mean treatment duration of 1.8 ± 0.9 cycles. No increased AST and ALT serum levels were detected and no woman reported symptoms suggestive of liver injury. The majority of women reported improvement of fibroids-related symptoms and a high degree of satisfaction with treatment. More than half of women had side effects, in most cases not as severe as to discontinue therapy. Ulipristal acetate did not worsen liver function or cause severe organ injury and showed high tolerability and satisfaction profiles. Therefore, we believe that it can still be considered a valuable option in the treatment of uterine fibroids.
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Affiliation(s)
- Simona Del Forno
- Gynecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital University of Bologna, Bologna, Italy
| | - Eugenia Degli Esposti
- Gynecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital University of Bologna, Bologna, Italy
| | - Paolo Salucci
- Gynecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital University of Bologna, Bologna, Italy
| | - Deborah Leonardi
- Gynecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital University of Bologna, Bologna, Italy
| | - Raffaella Iodice
- Gynecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital University of Bologna, Bologna, Italy
| | - Alessandro Arena
- Gynecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Gynecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital University of Bologna, Bologna, Italy
| | - Roberto Paradisi
- Gynecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Gynecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital University of Bologna, Bologna, Italy
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Wagner JK, Dathe K, Schaefer C, Hoeltzenbein M. Ulipristal acetate and pregnancy outcome-an observational study. Hum Reprod 2020; 35:751-758. [PMID: 32322890 DOI: 10.1093/humrep/deaa024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/25/2020] [Accepted: 02/03/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is the failure of the selective progesterone receptor modulator ulipristal acetate (UPA) as emergency contraception (EC; 30 mg, single) or inadvertent exposure for myoma treatment (5 mg/d) in pregnancy associated with a higher risk of birth defects, spontaneous abortion (SAB) or elective termination of pregnancy (ETOP)? SUMMARY ANSWER We did not find an increased risk for birth defects, SABs or ETOPs after UPA exposure during implantation and early embryogenesis. WHAT IS KNOWN ALREADY Pregnancy outcome data after exposure to UPA are very limited. In cases of EC failure or unplanned pregnancy during myoma treatment, women need well-grounded risk assessment to minimize anxiety and prevent unjustified termination of pregnancy. STUDY DESIGN, SIZE, DURATION Observational study of prospectively ascertained pregnancies from the German Embryotox institute with UPA exposure (EC, n = 95; myoma, n = 7). Four retrospectively reported pregnancy outcomes were evaluated separately. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 226 requests on ulipristal were directed to the German Embryotox institute during the study period 2010-2018. Outcomes of pregnancies exposed-(i) precycle, (ii) preconceptional or (iii) first trimester-were ascertained using standardized questionnaires. Descriptive statistics were applied. MAIN RESULTS AND THE ROLE OF CHANCE Failed EC with UPA resulted in 95 prospectively ascertained pregnancies, of which 56 had completed follow-up: 37 live births, 7 SABs and 12 ETOPs. There was no major birth defect. Just 34% of women had taken UPA during the fertile window. Seven prospectively enrolled pregnancies were treated for myoma and had known pregnancy outcomes: five healthy live births and two SABs. Among the four retrospectively reported pregnancies after EC, there was one child diagnosed with Beckwith-Wiedemann syndrome (BWS). LIMITATIONS, REASONS FOR CAUTION Our limited sample size does not allow concluding safety of UPA use in pregnancy. WIDER IMPLICATIONS OF THE FINDINGS We provide a preliminary basis for reassuring women who wish to carry their pregnancy to term after EC or myoma treatment with UPA. However, because of the report of a BWS after UPA exposure, a possible epigenetic effect could not be excluded and requires further evaluation. STUDY FUNDING/COMPETING INTEREST(S) This work was performed with financial support from the German Federal Institute for Drugs and Medical Devices (BfArM). All authors declare that they have no conflicts of interest. TRIAL REGISTRATION NUMBER Registered with the German Clinical Trial Register (DRKS00015155).
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Affiliation(s)
- Jenny Katharina Wagner
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Katarina Dathe
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Christof Schaefer
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Maria Hoeltzenbein
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
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Small B, Millard CEF, Kisanga EP, Burman A, Anam A, Flannery C, Al-Hendy A, Whirledge S. The Selective Progesterone Receptor Modulator Ulipristal Acetate Inhibits the Activity of the Glucocorticoid Receptor. J Clin Endocrinol Metab 2020; 105:5609012. [PMID: 31665442 PMCID: PMC7112983 DOI: 10.1210/clinem/dgz139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/22/2019] [Indexed: 12/19/2022]
Abstract
CONTEXT The selective progesterone modulator ulipristal acetate (ulipristal) offers a much-needed therapeutic option for the clinical management of uterine fibroids. Although ulipristal initially passed safety evaluations in Europe, postmarketing analysis identified cases of hepatic injury and failure, leading to restrictions on the long-term use of ulipristal. One of the factors potentially contributing to significant side effects with the selective progesterone modulators is cross-reactivity with other steroid receptors. OBJECTIVE To determine whether ulipristal can alter the activity of the endogenous glucocorticoid receptor (GR) in relevant cell types. DESIGN Immortalized human uterine fibroid cells (UtLM) and hepatocytes (HepG2) were treated with the synthetic glucocorticoid dexamethasone and/or ulipristal. Primary uterine fibroid tissue was isolated from patients undergoing elective gynecological surgery and treated ex vivo with dexamethasone and/or ulipristal. In vivo ulipristal exposure was performed in C57Bl/6 mice to measure the effect on basal gene expression in target tissues throughout the body. RESULTS Dexamethasone induced the expression of established glucocorticoid-target genes period 1 (PER1), FK506 binding protein 51 (FKBP5), and glucocorticoid-induced leucine zipper (GILZ) in UtLM and HepG2 cells, whereas cotreatment with ulipristal blocked the transcriptional response to glucocorticoids in a dose-dependent manner. Ulipristal inhibited glucocorticoid-mediated phosphorylation, nuclear translocation, and DNA interactions of GR. Glucocorticoid stimulation of PER1, FKBP5, and GILZ was abolished by cotreatment with ulipristal in primary uterine fibroid tissue. The expression of glucocorticoid-responsive genes was decreased in the lung, liver, and uterus of mice exposed to 2 mg/kg ulipristal. Interestingly, transcript levels of Fkbp5 and Gilz were increased in the hippocampus and pituitary. CONCLUSIONS These studies demonstrate that ulipristal inhibits endogenous glucocorticoid signaling in human fibroid and liver cells, which is an important consideration for its use as a long-term therapeutic agent.
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Affiliation(s)
- Benjamin Small
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Charles E F Millard
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Edwina P Kisanga
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Andreanna Burman
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Anika Anam
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Endocrinology, Yale School of Medicine, New Haven, Connecticut
| | - Clare Flannery
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Endocrinology, Yale School of Medicine, New Haven, Connecticut
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois
| | - Shannon Whirledge
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
- Correspondence and Reprint Requests: Shannon Whirledge, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 310 Cedar St, Office LSOG 204C, New Haven, CT, 06510. E-mail:
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Cleland K, Wagner B, Smith NK, Trussell J. "My BMI is too high for Plan B." A changing population of women seeking ulipristal acetate emergency contraception online. Women Health 2020; 60:241-248. [PMID: 31284850 PMCID: PMC6946884 DOI: 10.1080/03630242.2019.1635560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 12/30/2022]
Abstract
Emergency contraceptive (EC) pills may be less effective for women with higher body mass index (BMI), but little is known about public response to the fact that EC may lose efficacy as weight increases. In November 2013, European authorities changed the label for a levonorgestrel EC product to warn of a reduction in effectiveness for women with higher BMI, garnering significant media coverage in the United States. Ulipristal acetate (UPA) EC may be more effective than levonorgestrel for women with BMI levels designated as obese. Among 8,019 women who received UPA from the online pharmacy KwikMed from 2011 to 2015 and self-reported their height, weight and reasons for seeking UPA online, we analyzed changes in the proportion of women in different BMI categories before and after the label change. For the 25 month-period after the label change, the proportion of women in the obese category rose by 26.7 percentage points relative to the 35 months before (B = 0.2665, p < .01). Mean BMI (25.5 versus 29.4, p < .001) and average weight (148.6 pounds versus 175.5 pounds, p < .001) of users were higher after the label change. Some women appear to have acted on the information that EC efficacy may be associated with body weight.
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Affiliation(s)
| | - Brandon Wagner
- Office of Population Research, Princeton University
- Texas Tech University
| | | | - James Trussell
- Office of Population Research, Princeton University
- Dr. Trussell is now deceased
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Szydłowska I, Marciniak A, Nawrocka-Rutkowska J, Rył A, Starczewski A. Predictive Factors of Response to Selective Progesterone Receptor Modulator ( Ulipristal Acetate) in the Pharmacological Treatment of Uterine Fibroids. Int J Environ Res Public Health 2020; 17:ijerph17030798. [PMID: 32012826 PMCID: PMC7037608 DOI: 10.3390/ijerph17030798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/13/2020] [Accepted: 01/24/2020] [Indexed: 12/26/2022]
Abstract
Background: Selective progesterone receptor modulator ulipristal acetate (UPA) is a drug used in management of symptomatic myomas. It was observed that the response to UPA treatment in uterine myomas varied amongst patients. An attempt was thus made at establishing predictive factors conducive to better reaction to treatment with UPA. The aim of this study was to assess the efficacy of UPA treatment in women with myomas, depending on pretreatment myomas’ volume, number of myomas, age of patients, estrogenic status of women, and pretreatment blood flow in uterine arteries. Materials and methods: The study included patients with one to four myomas. The UPA treatment was a preparation stage for surgical treatment in all patients. The study group was divided into the subgroups according to pretreatment myomas’ volume, number of myomas, age of patients, estrogenic status of women, and pretreatment blood flow in uterine arteries. Results: A better effect of reduction in size of myomas after UPA treatment was noted when pretreatment myomas’ volume was lower than 30 cm3. A significant reduction in fibroids’ size was observed after UPA therapy independently of the number of myomas and age of patients. A good response after the UPA therapy was observed when pretreatment estradiol concentration was below 50 pg/mL and when uterine artery resistance index (RI) was above 0.8. Conclusions: Our research demonstrates that treatment with ulipristal acetate is an efficient method in preoperative preparation of patients with uterine fibroids. The most important factor of positive response to UPA therapy is myoma volume. The number of myomas and patient’s age do not interfere with effects of UPA therapy. Pretreatment estradiol concentration is significant, yet secondary for the effects of therapy. The UPA therapy has no impact on blood flow in the uterine arteries and no adverse influence on estradiol concentrations.
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Affiliation(s)
- Iwona Szydłowska
- Department of Gynecology, Endocrinology and Gynecological Oncology, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
| | - Aleksandra Marciniak
- Department of Gynecology, Endocrinology and Gynecological Oncology, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
- Correspondence: ; Tel.: +48-91-425-0541
| | - Jolanta Nawrocka-Rutkowska
- Department of Gynecology, Endocrinology and Gynecological Oncology, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
| | - Aleksandra Rył
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland
| | - Andrzej Starczewski
- Department of Gynecology, Endocrinology and Gynecological Oncology, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
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Irahara M, Maejima Y, Shinbo N, Yamauchi Y, Mizunuma H. Ulipristal acetate for Japanese women with symptomatic uterine fibroids: A double-blind, randomized, phase II dose-finding study. Reprod Med Biol 2020; 19:65-74. [PMID: 31956287 PMCID: PMC6955589 DOI: 10.1002/rmb2.12304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/05/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE A multicenter, randomized, double-blind, placebo-controlled trial was conducted to evaluate the efficacy, safety, and appropriate dose of ulipristal acetate (UPA) in Japanese women with symptomatic uterine fibroids (UFs). METHODS A total of 121 premenopausal women with UFs were enrolled to receive either placebo, UPA-2.5 mg, UPA-5 mg, UPA-10 mg, or leuprorelin acetate (LEU), a reference drug, for 12 weeks. The primary end point was the rate of patients having achieved amenorrhea for 35 days at Week 12. RESULTS The rates for amenorrhea were 4.5%, 60.0%, 72.7%, 88.0%, and 76.2% in the placebo, UPA-2.5 mg, UPA-5 mg, UPA-10 mg, and LEU groups, respectively. The median times to amenorrhea were 20.0, 5.0, 5.0, and 23.0 days for treatment with UPA-2.5 mg, UPA-5 mg, UPA-10 mg, and LEU, respectively. A significant dose-response of UPA for the rate of amenorrhea was observed. The overall incidence rates of adverse events were 45.8% in the placebo group, 56.5%-80.0% in the UPA groups, and 100.0% in the LEU group. There were no notable safety issues with UPA. CONCLUSIONS Ulipristal acetate was effective and well tolerated in Japanese women with UFs. The recommended dose of UPA is considered to be 10 mg.
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Abstract
To evaluate quality of life and sexual function of childbearing-age women, affected by uterine fibromatosis undergoing medical treatment with ulipristal acetate. The data obtained by filling the questionnaires European Quality of Life Five-Dimension Scale and modified Female Sexual Function Index, were analyzed to assess UPA usefulness in improving QoL and sexual activity. A total of 139 patients affected by uterine fibromatosis undergoing conservative ulipristal acetate treatment were enrolled in this prospective observational cohort study. Seventy-one women (average age 46.5 years) answered the questionnaires: QoL and sexuality were evaluated before and after ulipristal acetate treatment. 59 patients (83.1%) had an improvement of QoL and general health state, with a reduction of VAS score after ulipristal acetate treatment. EQ-5D-5L showed a statistically significant improvement of usual act impairment, mobility, discomfort, anxiety/depression (p < .0005). There was no difference in personal care management after therapy. Modified FSFI showed a statistically significant improvement (p < .0001) of sexual satisfaction and sexual life. A not statistically significant improvement in dyspareunia was also highlighted. This study provides a clear picture about QoL impact on women and confirms the effectiveness of the ulipristal acetate in improving different aspects of daily and sexual life of patients undergoing medical treatment.
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Affiliation(s)
- Antonella Biscione
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
| | - Valeria Barra
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
| | - Emma Bellone
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
| | - Filiberto Maria Severi
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
| | - Stefano Luisi
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
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De Gasperis-Brigante C, Singh SS, Vilos G, Kives S, Murji A. Pregnancy Outcomes Following Ulipristal Acetate for Uterine Fibroids: A Systematic Review. J Obstet Gynaecol Can 2018; 40:1066-1076.e2. [PMID: 30103881 DOI: 10.1016/j.jogc.2018.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine pregnancy and fetal outcomes following treatment with ulipristal acetate (UPA) for symptomatic uterine fibroids. METHODS We conducted a systematic review and case series. We searched MEDLINE, EMBASE, PubMed, Web of Science, and Cochrane Register from inception to February 2017. From January 2014 to July 2017, we carried out a multi-centre retrospective chart review. All human studies that reported at least one pregnancy following UPA treatment were included. The case series included patients who conceived during/following UPA treatment. Titles and abstracts were screened for eligibility by two independent reviewers, and full texts were evaluated for inclusion and study quality. Data from the systematic review and case series were synthesized and reported separately. RESULTS Seven studies were included (six case reports, one retrospective series) and contributed 24 post-UPA pregnancies (19 live births, six spontaneous abortions [SA]). The case series contributed 47 post-UPA pregnancies (31 live births, 13 SA, 1 fetal death, 2 terminations, 1 ongoing). In total, 71 pregnancies were evaluated (44 underwent myomectomy post-UPA; 27 without interval surgery). Five pregnancies occurred during UPA use (10-36 days of exposure) and resulted in three live births, one SA, and one termination. Five women who did not undergo interval myomectomy experienced delivery complications related to their fibroid. CONCLUSIONS This is the first systematic review and largest reported case series evaluating pregnancy outcomes following UPA treatment for uterine fibroids. UPA alone, or in conjunction with surgery, can permit conception and favorable pregnancy outcomes.
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de Milliano I, Huirne JAF, Thurkow AL, Radder C, Bongers MY, van Vliet H, van de Lande J, van de Ven PM, Hehenkamp WJK. Ulipristal acetate vs gonadotropin-releasing hormone agonists prior to laparoscopic myomectomy (MYOMEX trial): Short-term results of a double-blind randomized controlled trial. Acta Obstet Gynecol Scand 2019; 99:89-98. [PMID: 31468503 PMCID: PMC6973004 DOI: 10.1111/aogs.13713] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/08/2019] [Accepted: 08/18/2019] [Indexed: 12/16/2022]
Abstract
Introduction Laparoscopic myomectomy can be difficult when fibroids are large and numerous. This may result in extensive intraoperative bleeding and the need for a conversion to a laparotomy. Medical pretreatment prior to surgery might reduce these risks by decreasing fibroid size and vascularization of the fibroid. We compared pretreatment with ulipristal acetate (UPA) vs gonadotropin‐releasing hormone agonists (GnRHa) prior to laparoscopic myomectomy on several intra‐ and postoperative outcomes. Material and methods We performed a non‐inferiority double‐blind randomized controlled trial in nine hospitals in the Netherlands. Women were randomized between daily oral UPA for 12 weeks and single placebo injection or single intramuscular injection with leuprolide acetate and daily placebo tablets for 12 weeks. The primary outcome was intraoperative blood loss. Secondary outcomes were reduction of fibroid volume, suturing time, total surgery time and surgical ease. Results Thirty women received UPA and 25 women leuprolide acetate. Non‐inferiority of UPA regarding intraoperative blood loss was not demonstrated. When pretreated with UPA, median intraoperative blood loss was statistically significantly higher (525 mL [348‐1025] vs 280 mL[100‐500]; P = 0.011) and suturing time of the first fibroid was statistically significantly longer (40 minutes [28‐48] vs 22 minutes [14‐33]; P = 0.003) compared with GnRHa. Pretreatment with UPA showed smaller reduction in fibroid volume preoperatively compared with GnRHa (−7.2% [−35.5 to 54.1] vs −38.4% [−71.5 to −19.3]; P = 0.001). Laparoscopic myomectomies in women pretreated with UPA were subjectively judged more difficult than in women pretreated with GnRHa. Conclusions Non‐inferiority of UPA in terms of intraoperative blood loss could not be established, possibly due to the preliminary termination of the study. Pretreatment with GnRHa was more favorable than UPA in terms of fibroid volume reduction, intraoperative blood loss, hemoglobin drop directly postoperatively, suturing time of the first fibroid and several subjective surgical ease parameters.
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Affiliation(s)
- Inge de Milliano
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, University Medical Center Amterdam, location VU Medical Center, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, University Medical Center Amterdam, location VU Medical Center, Amsterdam, The Netherlands
| | - Andreas L Thurkow
- Department of Obstetrics and Gynecology, University Medical Center Amterdam, location Academic Medical Center, Amsterdam, The Netherlands
| | - Celine Radder
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, The Netherlands.,Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Huib van Vliet
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jonas van de Lande
- Department of Obstetrics and Gynecology, Spaarne Gasthuis, Haarlem, The Netherlands
| | | | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, University Medical Center Amterdam, location VU Medical Center, Amsterdam, The Netherlands
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Dolmans MM, Donnez J, Fellah L. Uterine fibroid management: Today and tomorrow. J Obstet Gynaecol Res 2019; 45:1222-1229. [PMID: 31141843 DOI: 10.1111/jog.14002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/28/2019] [Indexed: 12/11/2022]
Abstract
Current treatments for fibroids are mainly surgical and expensive, so alternatives need to be found. It is, therefore, vital to develop and evaluate alternatives to surgical procedures, especially when fertility preservation is the goal. Selective progesterone receptor modulators (SPRMs) are synthetic compounds that have either an agonistic or antagonistic impact on target tissues determined by their binding to progesterone receptors. Their mixed activity depends on recruitment of cofactors that regulate transcription along so-called genomic pathways, as well as nongenomic interactions with other signaling pathways. There is no doubt that surgery remains indicated in some instances, but we must now establish whether use of SPRMs (notably ulipristal acetate) allows less invasive surgery or even complete avoidance of surgery. Long-term intermittent administration of ulipristal acetate will undoubtedly change our approach to the management of uterine fibroids according to the International Federation of Gynecology and Obstetrics classification, which provides a comprehensive basis for different treatment options. When considering less invasive techniques (uterus-sparing options like myomectomy), the choice is guided by the size, number and location of fibroids, as well as the personal experience of the gynecologist and available equipment. There is now a growing body of evidence pointing to the crucial role of progesterone pathways in the pathophysiology of uterine fibroids. SPRMs should, therefore, be considered an alternative to surgical therapy, or at least an adjunct to surgery, as illustrated in the algorithms. © 2019 Japan Society of Obstetrics and Gynecology.
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Affiliation(s)
- Marie-Madeleine Dolmans
- Gynecology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Pôle de Gynécologie, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Jacques Donnez
- Université Catholique de Louvain, Société de Recherche pour l'Infertilité (SRI), Brussels, Belgium
| | - Latifa Fellah
- Radiology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Gómez-Elías MD, May M, Munuce MJ, Bahamondes L, Cuasnicú PS, Cohen DJ. A single post-ovulatory dose of ulipristal acetate impairs post-fertilization events in mice. Mol Hum Reprod 2019; 25:257-264. [PMID: 30824928 DOI: 10.1093/molehr/gaz013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/30/2019] [Accepted: 02/26/2019] [Indexed: 02/06/2023] Open
Abstract
Ulipristal acetate (UPA) is a selective progesterone receptor modulator used for emergency contraception that has proven to be highly effective in preventing pregnancy when taken up to 120 h after unprotected sexual intercourse. Even though it may act mainly by delaying or inhibiting ovulation, additional effects of UPA on post-fertilization events cannot be excluded. Therefore, the aim of this study was to determine whether a single post-ovulatory dose of UPA could prevent pregnancy using the mouse as a pre-clinical model. Mated females received a single dose of UPA (40 mg/kg) on Day E1.5 or E2.5 (E0.5: copulatory plug detection) and post-fertilization events were evaluated. Our studies revealed that UPA administration produced a significant decrease in the number of conceptuses compared to control. Moreover, UPA-treated females exhibited a lower number of early implantation sites on Day E5.5, despite normal in vivo embryo development and transport to the uterus at E3.5. Administration of UPA produced histological and functional alterations in the uterine horns, i.e., a dyssynchronous growth between endometrial glands and stroma, with non-physiological combination of both fractions compared to controls, and a completely impaired ability to respond to an artificial decidualization stimulus. Altogether, our results show that the administration of a single post-ovulatory dose of UPA impairs mouse pregnancy probably due to an effect on embryo-uterine interaction, supporting additional effects of the drug on post-fertilization events. Although these studies cannot be performed with human samples, our results with the mouse model provide new insights into the mechanism of action of UPA as an emergency contraception method.
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Affiliation(s)
- Matías D Gómez-Elías
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - María May
- Instituto de Investigaciones Farmacológicas (ININFA-UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - María José Munuce
- Laboratory of Reproductive Medicine, Biochemical Chemistry Area, School of Biochemical and Pharmaceutical Sciences, National University of Rosario, Rosario, Argentina
| | - Luis Bahamondes
- Department of Obstetrics and Gynaecology, School of Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Patricia S Cuasnicú
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Débora J Cohen
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
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Mallick R, Oxley S, Odejinmi F. The Use of Ulipristal Acetate (Esmya) Prior to Laparoscopic Myomectomy: Help or Hindrance? Gynecol Minim Invasive Ther 2019; 8:62-66. [PMID: 31143625 PMCID: PMC6515756 DOI: 10.4103/gmit.gmit_79_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/13/2018] [Accepted: 12/24/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction: The aim of this study was to assess the operative effects, both positive and negative, of pretreatment with ulipristal acetate (UPA) on laparoscopic myomectomy. Materials and Methods: We conducted a retrospective analysis of prospectively collected data from patients who underwent a laparoscopic myomectomy over a 2-year period. Results: A total of 62 patients were included, of which 10 received a 3-month preoperative course of UPA, and 52 patients received no pretreatment. There was no statistically significant difference between the two groups (no pretreatment vs. UPA pretreatment) with regard to blood loss (214.4 [±214.96] vs. 160 [±51.64], P = 0.432), operating time (111.64 [±41.8] vs. 117.5 [±50.4], P = 0.694), and duration of inpatient stay (1.27 [±0.56] vs. 1.11 [±0.33], P = 0.419). There were no complications in either group. In 100% of cases with UPA pretreatment, a distortion of the fibroid capsule with a more technically challenging dissection was noted, compared to 0% in the no pretreatment group. This anatomical distortion may result in more cases of incomplete resection and a potentially higher risk of recurrence. Conclusion: We conclude that UPA confers no operative benefits and should be used with caution in the presurgical treatment of fibroids. The use of UPA may indeed result in a more technically difficult myomectomy with distorted cleavage planes and carry a potential risk of incomplete resection.
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Affiliation(s)
- Rebecca Mallick
- Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals NHS Trust, Princess Royal Hospital, Haywards Heath, England, UK
| | - Sam Oxley
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, Whipps Cross Hospital, London, UK
| | - Funlayo Odejinmi
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, Whipps Cross Hospital, London, UK
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Ditmars L, Rafie S, Kashou G, Cleland K, Bayer L, Wilkinson TA. Emergency Contraception Counseling in California Community Pharmacies: A Mystery Caller Study. Pharmacy (Basel) 2019; 7:pharmacy7020038. [PMID: 31018486 PMCID: PMC6630498 DOI: 10.3390/pharmacy7020038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/05/2019] [Accepted: 04/15/2019] [Indexed: 11/25/2022] Open
Abstract
This study was conducted to determine which emergency contraception (EC) methods are offered by community pharmacists in response to patient calls. Female mystery callers called all community pharmacies in two California cities using standardized scripts. The callers inquired about options available to prevent pregnancy after sex and whether that method was available at the pharmacy, using follow-up probes if necessary. A total of 239 calls were completed in San Diego (n = 127, 53%) and San Francisco (n = 112, 47%). Pharmacists indicated availability at most sites (n = 220, 92%) with option(s) reported as levonorgestrel only (LNG; n = 211, 88.3%), both ulipristal acetate (UPA) and LNG (n = 4, 1.6%), UPA only (n = 1, 0.4%), or non-specific EC (n = 4, 1.7%). Nineteen pharmacies (7.9%) did not have EC available on the day of the call. Following additional probing, some pharmacists discussed UPA (n = 49, 20.5%) or the copper intrauterine device (n = 1, 0.4%) as EC options. LNG EC products were available same-day in 90.1% of pharmacies, whereas UPA was available same-day in 9.6% of pharmacies. The majority of pharmacies called in this study offered and stocked at least one EC option, but the focus of discussions was on LNG and matched what was in stock and available.
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Affiliation(s)
- Lindsay Ditmars
- Department of Pharmacy, UC San Diego Health, San Diego 92103, CA, USA.
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla 92093, CA, USA.
| | - Sally Rafie
- Department of Pharmacy, UC San Diego Health, San Diego 92103, CA, USA.
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla 92093, CA, USA.
- Birth Control Pharmacist, San Diego 92122, CA, USA.
| | | | - Kelly Cleland
- Office of Population Research, Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton 08540, NJ, USA.
| | - Lisa Bayer
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland 97239, OR, USA.
| | - Tracey A Wilkinson
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis 46202, IN, USA.
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