Dienogest vs GnRH agonists as postoperative therapy after laparoscopic eradication of deep infiltrating endometriosis with bowel and parametrial surgery: a randomized controlled trial

Marcello Ceccaroni, Ceccaroni M, Roberto Clarizia, Clarizia R, Stefano Liverani, Liverani S, Agnese Donati, Ceccarello M, Matteo Ceccarello, M Manzone, Manzone M, Maria Manzone, Roviglione G, Giovanni Roviglione, Ferrero S, Simone Ferrero
Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology · 2021 · vol. 37(10) , pp. 930–933 · doi:10.1080/09513590.2021.1929151 · PMID:34036845 · W3165245724
RCT OA: closed CC0 ⤵ 41 in-corpus citations
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This trial found dienogest to be non-inferior to GnRH agonists in reducing pain recurrence after deep infiltrating endometriosis surgery, with better patient tolerability and similar relapse and pregnancy rates.

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Abstract

BACKGROUND: The recurrence of deep infiltrating endometriosis (DIE) after its surgical excision is a big problem: postoperative treatment is crucial. OBJECTIVE: To compare two postoperative treatments: Dienogest and GnRH agonists. DESIGN: Prospective Randomized Controlled Trial (RCT). PATIENTS: 146 women submitted to laparoscopic eradication of DIE with bowel and parametrial surgery. INTERVENTIONS: Patients were randomized into two groups. Group A (n = 81) received Triptorelin or Leuprorelin 3.75 mg every 4 weeks for 6 months. Group B (n = 65) received Dienogest 2 mg/day for at least 6 months. A first interview made after six months valued compliance to therapy, treatment tolerability, pain improvement, and side effects. A second interview at 30 ± 6 months valued pain relapse, imaging relapse, and pregnancy rate. MAIN OUTCOMES: The primary outcome was to demonstrate the non-inferiority of Dienogest about the reduction in pain recurrence. Secondary outcomes were differences in terms of treatment tolerability, side effects, imaging relapse rate, and pregnancy rate. RESULTS: Both Dienogest and GnRH agonists were associated with a highly significant reduction of pain at 6 and 30 months, without any significant difference (p < .001). About treatment tolerability, a more satisfactory profile was reported with Dienogest (p = .026). No difference in terms of clinical relapse, imaging relapse, and live births was found. CONCLUSIONS: Dienogest has proven to be as effective as GnRH agonists in preventing recurrence of DIE and associated pelvic pain after surgery. Also, it is better tolerated by patients.

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Condition tags

endometriosischronic_pelvic_paindie_deep_infiltrating

MeSH descriptors

Endometriosis Gonadotropin-Releasing Hormone Laparoscopy Nandrolone Postoperative Care Endometriosis Endometriosis Endometriosis Endometriosis Female Female Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Humans Humans Intestines Intestines Intestines Laparoscopy Laparoscopy

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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Cited by (44)

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