Treatment of endometriosis with a decreasing dosage of a gonadotropin-releasing hormone agonist (nafarelin): a pilot study with low-dose agonist therapy (“draw-back” therapy)

M Tahara, Masahiro Tahara, Tahara M, Tetsu Matsuoka, T Matsuoka, Matsuoka T, Yokoi T, T Yokoi, Takeshi Yokoi, Tasaka K, K Tasaka, Keiichi Tasaka, Hirohisa Kurachi, H Kurachi, Kurachi H, Y Murata, Murata Y, Yuji Murata
Fertility and Sterility · 2000 · vol. 73(4) , pp. 799–804 · doi:10.1016/s0015-0282(99)00636-6 · PMID:10731543 · W2132722874
article OA: closed CC0 ⤵ 31 in-corpus citations
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This pilot study investigated the efficacy of a "draw-back" therapy for endometriosis, involving a decreasing dosage of nafarelin, a gonadotropin-releasing hormone agonist.

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Abstract

ObjectiveTo evaluate the efficacy of half-dose GnRH agonist therapy for endometriosis.DesignProspective, longitudinal pilot study.SettingOsaka University Hospital.Patient(s)Patients with symptomatic endometriosis.Intervention(s)Fifteen patients were randomized to receive either full-dose nafarelin treatment (200 microgram b.i.d.) for 24 weeks (n = 7) or full-dose nafarelin treatment for 4 weeks followed by half-dose nafarelin treatment (200 microgram daily) for 20 weeks (n = 8).Main outcome measure(s)Clinical symptoms and the results of physical examinations. Serum E(2) and carcinoma antigen 125 (CA125) levels, lipid profiles, and urinary levels of the N-telopeptide of type I collagen. Bone mineral density of the lumbar spine.Result(s)Subjective and objective manifestations of endometriosis were decreased to a similar extent in both study groups. Adverse effects were markedly reduced with half-dose administration. In the half-dose group, the mean serum E(2) level was significantly suppressed by 4 weeks of treatment with full-dose nafarelin and remained at approximately 30 pg/mL with half-dose nafarelin. Loss of bone mineral density was significantly less with half-dose treatment.Conclusion(s)Half-dose administration of nafarelin after pituitary down-regulation with full-dose nafarelin ("draw-back" therapy) is a new protocol for the treatment of endometriosis that is effective and associated with fewer adverse effects.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Hormones Nafarelin Administration, Intranasal Bone Density Bone Density CA-125 Antigen CA-125 Antigen CA-125 Antigen Collagen Collagen Collagen Dizziness Dizziness Dose-Response Relationship, Drug Down-Regulation Endometriosis Estradiol Estradiol Female

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