Comparison of The Efficacy of Letrozole Versus Danazol in Pain Relief in Endometriosis

Sundus Nawaz, Sadia Habib, Saba Ayoub, Ghazala Shams, Nimra Naeem, Ruqiya Sultana
In: Pakistan Journal of Health Sciences · 2022 · pp. 248–252 · doi:10.54393/pjhs.v3i06.345 · W4310806997
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Letrozole demonstrated greater efficacy than danazol in providing pain relief for endometriosis patients over a three-month treatment period.

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This randomized controlled trial compared the pain-relieving efficacy of letrozole versus danazol in 240 women with diagnosed endometriosis at Ayub Teaching Hospital (Pakistan) between 2018 and 2021, with outcomes assessed after 3 months using visual analog scale (VAS) scores and symptom relief. Baseline VAS scores were similar between groups, but after treatment the letrozole group had lower mean VAS scores (2.94±1.96) than the danazol group (3.99±1.90; p=0.002), and a higher proportion reported symptom relief (47.5% overall; p=0.039). The paper does not report major caveats in the provided abstract, but its efficacy assessment is limited to a short 3-month follow-up period. This paper is centrally about endometriosis — it directly compares letrozole versus danazol for endometriosis-related pelvic pain relief.

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Abstract

Endometriosis is a chronic inflammatory disease defined as the presence of endometrium-like tissue outside the uterus which is responsive to the estrogen levels in blood circulation. Objective: To compare the efficacy of letrozole versus danazol in pain relief in endometriosis. Methods: This randomized controlled trial was conducted at the department of Obstetrics & Gynecology, Ayub Teaching Hospital, Abbottabad, Pakistan from January 2018 to December 2021. Patients diagnosed with endometriosis were enrolled and detailed medical history was taken. Patients were randomly divided into either Letrozole (n=120) or Danazol (n=120) group. Both treatment groups were evaluated after 3 months of treatment and efficacy was compared in terms of pain relief in patients of endometriosis. Results: In a total of 240 patients, the mean age was 28.30±4.76 years. The mean endometrial cyst size was 2.48±1.14 cm. At baseline, mean visual analog scale (VAS) score was recorded as 5.46±1.09 points in letrozole group and 5.28±1.01 points in danazol group (p=0.186). After three months of treatment, the mean VAS score was 2.94±1.96 points in letrozole group and 3.99±1.90 points in danazol group (p=0.002). Relief of symptoms was observed in 114 (47.5%) women and more patients reported relief of symptoms in letrozole group (65 patients) than the danazol group (49 patients) (p=0.039). Conclusion: Letrozole was more effective as compare to danazol in relief of pain in patients with endometriosis
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Comparison of The Efficacy of Letrozole Versus Danazol in Pain Relief in Endometriosis Efficacy of Letrozole and Danazol in Endometriosis DOI: https://doi.org/10.54393/pjhs.v3i06.345Keywords: Endometriosis, Danazol, Letrozole, Pelvic Pain.Abstract Endometriosis is a chronic inflammatory disease defined as the presence of endometrium-like tissue outside the uterus which is responsive to the estrogen levels in blood circulation. Objective: To compare the efficacy of letrozole versus danazol in pain relief in endometriosis. Methods: This randomized controlled trial was conducted at the department of Obstetrics & Gynecology, Ayub Teaching Hospital, Abbottabad, Pakistan from January 2018 to December 2021. Patients diagnosed with endometriosis were enrolled and detailed medical history was taken. Patients were randomly divided into either Letrozole (n=120) or Danazol (n=120) group. Both treatment groups were evaluated after 3 months of treatment and efficacy was compared in terms of pain relief in patients of endometriosis. Results: In a total of 240 patients, the mean age was 28.30±4.76 years. The mean endometrial cyst size was 2.48±1.14 cm. At baseline, mean visual analog scale (VAS) score was recorded as 5.46±1.09 points in letrozole group and 5.28±1.01 points in danazol group (p=0.186). After three months of treatment, the mean VAS score was 2.94±1.96 points in letrozole group and 3.99±1.90 points in danazol group (p=0.002). Relief of symptoms was observed in 114 (47.5%) women and more patients reported relief of symptoms in letrozole group (65 patients) than the danazol group (49 patients) (p=0.039). Conclusion: Letrozole was more effective as compare to danazol in relief of pain in patients with endometriosis References Kim SH, Chae HD, Kim CH, Kang BM. Update on the treatment of endometriosis. Clinical and experimental reproductive medicine. 2013 Jun; 40(2):55. doi: 10.5653/cerm.2013.40.2.55 Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al. ESHRE guideline: endometriosis. Human reproduction open. 2022; 2022(2): hoac009. doi: 10.1093/hropen/hoac009 Kuznetsov L, Dworzynski K, Davies M, Overton C. Diagnosis and management of endometriosis: summary of NICE guidance. Bmj. 2017 Sep; 358. doi: 10.1136/bmj.j3935 Madny EH. Efficacy of letrozole in treatment of endometriosis-related pain. Middle East Fertility Society Journal. 2014 Mar; 19(1):64-8. doi: 10.1016/j.mefs.2013.04.007 Morotti M, Vincent K, Becker CM. Mechanisms of pain in endometriosis. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2017 Feb; 209: 8-13. doi: 10.1016/j.ejogrb.2016.07.497 Maddern J, Grundy L, Castro J, Brierley SM. Pain in endometriosis. 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Medical management of endometriosis in patients with chronic pelvic pain. InSeminars in reproductive medicine 2017 Jan; 35(1): 038-053. Thieme Medical Publishers. doi: 10.1055/s-0036-1597308 Stauffer F, Furet P, Floersheimer A, Lang M. New aromatase inhibitors from the 3-pyridyl arylether and 1-aryl pyrrolo [2, 3-c] pyridine series. Bioorganic & medicinal chemistry letters. 2012 Mar; 22(5): 1860-3. doi: 10.1016/j.bmcl.2012.01.076 Ferrero S, Gillott DJ, Venturini PL, Remorgida V. Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review. Reproductive Biology and Endocrinology. 2011 Dec; 9(1):1-0. doi: 10.1186/1477-7827-9-89 Rasul SG, Yaqub U, Manzoor M, Mubasshar H. Comparison of Letrozole versus Danazol for the Pain Management of Females Presented with Endometriosis. Annals of King Edward Medical University. 2017 Oct; 23(4): 514-8. doi: 10.21649/akemu.v23i4.2231 Roghaei MA, Ghasemi Tehrany H, Taherian A, Koleini N. Effects of letrozole compared with danazol on patients with confirmed endometriosis: a randomized clinical trial. International Journal of Fertility and Sterility. 2010 Jul; 4(2): 67-72. https://dx.doi.org/10.22074/ijfs.2010.45826 Almassinokiani F, Almasi A, Akbari P, Saberifard M. Effect of Letrozole on endometriosis-related pelvic pain. Medical Journal of the Islamic Republic of Iran. 2014; 28: 107. Barra F, Scala C, Mais V, Guerriero S, Ferrero S. Investigational drugs for the treatment of endometriosis, an update on recent developments. Expert opinion on investigational drugs. 2018 May; 27(5): 445-58. doi: 10.1080/13543784.2018.1471135 Goenka L, George M, Sen M. A peek into the drug development scenario of endometriosis–A systematic review. Biomedicine & Pharmacotherapy. 2017 Jun; 90: 575-85. doi: 10.1016/j.biopha.2017.03.092 Badawy AM, Elnashar AM, Mosbah AA. Aromatase inhibitors or gonadotropin‐releasing hormone agonists for the management of uterine adenomyosis: a randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica. 2012 Apr; 91(4): 489-95. doi: 10.1111/j.1600-0412.2012.01350.x Seal SL, Kamilya G, Mukherji J, De A, Ghosh D, Majhi AK. Aromatase inhibitors in recurrent ovarian endometriomas: report of five cases with literature review. Fertility and sterility. 2011 Jan; 95(1): 291-e15. doi: 10.1016/j.fertnstert.2010.05.021 Ailawadi RK, Jobanputra S, Kataria M, Gurates B, Bulun SE. Treatment of endometriosis and chronic pelvic pain with letrozole and norethindrone acetate: a pilot study. Fertility and sterility. 2004 Feb; 81(2): 290-6. doi: 10.1016/j.fertnstert.2003.09.029 Downloads Published How to Cite Issue Section License Copyright (c) 2022 Pakistan Journal of Health Sciences This work is licensed under a Creative Commons Attribution 4.0 International License. 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VAS-pain

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endometriosis

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