Synergistic Effects of E2MATE and Norethindrone Acetate on Steroid Sulfatase Inhibition: A Randomized Phase I Proof-of-Principle Clinical Study in Women of Reproductive Age

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This randomized study found that combined treatment with E2MATE and norethindrone acetate synergistically inhibited steroid sulfatase activity in healthy women.

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This randomized, double-blind, placebo-controlled phase I study evaluated the pharmacodynamics, pharmacokinetics, and safety of the steroid sulfatase inhibitor PGL2001 (E2MATE) and the progestin norethindrone acetate (NETA) alone or in combination in 24 healthy women of reproductive age treated for 4 weeks. Treatment with PGL2001 reduced steroid sulfatase (STS) activity in the endometrium by 91% (±3%), and PGL2001 plus NETA reduced STS activity by 96% (±4%), with comparable inhibition observed 1 month after stopping treatment. The combined regimen produced significantly higher STS inhibition than either approach alone at both time points. The main limitation is that this proof-of-principle was conducted in healthy participants rather than patients with endometriosis or adenomyosis. This paper is centrally about endometriosis — it directly tests the synergistic inhibition of local estrogen production via STS inhibition (E2MATE) combined with ovarian estrogen reduction (norethindrone acetate) as a potential endometriosis therapy.

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Abstract

The combination of a progestin such as norethindrone acetate (NETA) reducing the ovarian estrogen production with a steroid sulfatase (STS) inhibitor (STS-I) decreasing the local estrogen production could result in a new treatment option for endometriosis. The study reported was a randomized, double-blind, and placebo-controlled study to investigate the pharmacodynamics, pharmacokinetics, and safety of the STS-I PGL2001 (E2MATE) and NETA. A total of 24 healthy women of reproductive age were treated with weekly doses of PGL2001 or daily doses of NETA or a combination of both compounds for 4 weeks. Four weeks of treatment with PGL2001 or PGL2001 + NETA reduced the STS activity in the endometrium by 91% (±3%) and 96% (±4%), respectively, and comparable values were observed 1 month after the treatment was stopped. The combined treatment of PGL2001 + NETA led to significantly higher STS inhibition at both times (P < .01 and P < .05, respectively). This study showed that administration of PGL2001 alone at 4 mg/week or combined with NETA to healthy women of reproductive age led to STS inhibition and changes in functional STS biomarkers in the endometrium, resulting in synergistic effects of PGL2001 and NETA on STS activity. Similar content being viewed by others

References

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Int J Fertil Womens Med. 1998;43(1):24–27. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Pohl, O., Bestel, E. & Gotteland, JP. Synergistic Effects of E2MATE and Norethindrone Acetate on Steroid Sulfatase Inhibition: A Randomized Phase I Proof-of-Principle Clinical Study in Women of Reproductive Age. Reprod. Sci. 21, 1256–1265 (2014). https://doi.org/10.1177/1933719114522526 Published: Issue date: DOI: https://doi.org/10.1177/1933719114522526

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MeSH descriptors

Endometrium Estradiol Norethindrone Reproduction Steryl-Sulfatase Adult Double-Blind Method Drug Synergism Drug Therapy, Combination Endometrium Endometrium Estradiol Estradiol Estradiol Female Humans Norethindrone Norethindrone Norethindrone Norethindrone Acetate

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