Medikamentöse Therapie der Endometriose mit GnRH-Antagonisten

W. Küpker, R. Felberbaum, Eduard Malik, K. Diedrich
In: Der Gynäkologe · 2002 · vol. 35(3) , pp. 243–249 · doi:10.1007/s00129-002-1176-6 · W1997052447
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A pilot study of GnRH antagonist treatment for endometriosis found complete symptom relief without estrogen withdrawal side effects and improved disease stage in most patients.

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The paper investigates whether a GnRH antagonist (Cetrotide®) can be used for medical treatment of symptomatic endometriosis, focusing on symptom control and endometriosis regression while limiting estrogen-withdrawal side effects. In a pilot study of women treated after primary diagnostic laparoscopy, all participants reported complete relief of complaints without typical estrogen-deprivation symptoms, and second-look laparoscopy showed improved endometriosis stage in all cases except those with stage IV (ASRM). A sequential regimen of Cetrotide® 3 mg once weekly for 8 weeks is presented as an alternative approach, with the caveat that regression appears unaffected only when baseline estrogen levels are preserved and that metabolic changes require further study. This paper is centrally about endometriosis — it evaluates sequential GnRH antagonist therapy (Cetrotide®) for symptom relief and disease stage changes observed on second-look laparoscopy.

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Zusammenfassung Endometriose scheint auf Östrogenentzug anzusprechen. Die damit verbundenen Nebenwirkungen können suffizient mit der Add-back-Therapie vermieden werden, indem niedrig dosierte Östrogene und Gestagene als Monosubstanzen oder in Kombination mit einem GnRH-Agonisten eingesetzt werden. Ziel einer Pilotstudie war es, die Anwendung eines GnRH-Antagonisten in der Behandlung der Endometriose zu überprüfen. Alle nach primärer diagnostischer Laparoskopie mit einem Antagonisten behandelten Patientinnen berichteten über komplette Beschwerdefreiheit, typische Östrogenentzugserscheinungen traten nicht auf. Die Second-look-Laparoskopie zeigte eine Verbesserung des Endometriosestadiums in allen Fällen außerhalb des Stadiums IV (nach ASRM). Die sequenzielle Gabe eines GnRH-Antagonisten (Cetrotide®) in der 3-mg-Dosierung einmal wöchentlich über einen Zeitraum von 8 Wochen bietet somit eine Alternative in der medikamentösen Therapie der symptomatischen Endometriose. Bei basal erhaltenen Östrogenspiegeln wird die Regression der Endometrioseherde offensichtlich nicht beeinflusst. Abstract Sequential administration of the GnRH antagonist Cetrotide® creates a new opportunity for medical treatment of symptomatic endometriosis. Sequential treatment with Cetrotide® may limit side effects with immediate, effective suppression of endogenous gonadotropins while preserving a basic estrogen production during the course of treatment that apparently does not influence regression of disease. The weekly application of a GnRH antagonist in women with endometriosis appears to be a simple, effective and convenient approach to reach the “therapeutic window” without any signs of compromising side effects. No further drugs are necessary to apply. No metabolic changes are to be expected, which has to be proved in detail in further studies. The use of GnRH antagonists in women with endometriosis could be a reasonable therapeutic option especially if conservative treatment is indicated as preoperative or to circumvent or avoid repetitive surgical intervention. Similar content being viewed by others Author information Authors and Affiliations Rights and permissions About this article Cite this article Küpker, W., Felberbaum, R., Malik, E. et al. Medikamentöse Therapie der Endometriose mit GnRH-Antagonisten. Gynäkologe 35, 243–249 (2002). https://doi.org/10.1007/s00129-002-1176-6 Published: Issue date: DOI: https://doi.org/10.1007/s00129-002-1176-6

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