Gibt es neue Hoffnungsträger abseits der chirurgischen Endometriosetherapie?
This review discusses conservative medical treatment options for endometriosis, including NSAIDs, progestins, COCs, GnRH agonists, and the emerging GnRH antagonist elagolix.
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Der Übersichtsartikel untersucht konservative medikamentöse Therapieoptionen bei Endometriose-assoziierten Symptomen und stellt dazu unter anderem NSAR/ Gestagene, GnRH-Agonisten und GnRH-Antagonisten (v. a. Elagolix, Linzagolix, Relugolix) sowie weitere hormonelle Wirkstoffklassen wie Aromatasehemmer, SERM (Raloxifen) und selektive Progesteronrezeptormodulatoren (Ulipristalacetat) dar. Kernaussagen sind, dass Gestagenpräparate weiterhin Mittel der ersten Wahl sind, GnRH-Antagonisten den Flare-up-Effekt vermeiden und insbesondere für Relugolix in Studien mit Add-back eine vergleichbare Wirkung bei geringerem Knochendichteverlust im Vergleich zur Monotherapie gezeigt wurde, während für Raloxifen eine unzufriedenstellende Rezidivprävention berichtet wird; zudem werden Limitationen wie fehlende Add-back-Daten für einzelne Substanzen, ausstehende non-inferiority-Studien und teils unterbrochene/noch laufende Studien (z. B. wegen COVID-19) genannt. Der Text betont außerdem die Bedeutung von kontinuierlicher Einnahme und die Berücksichtigung von Nebenwirkungsprofilen, insbesondere beim Einfluss auf die Knochendichte. This paper is centrally about endometriosis — es ist eine deutschsprachige therapeutische Übersicht zu konservativen Hoffnungsträgern neben der chirurgischen Endometriosetherapie, mit Fokus auf neue/aktuelle medikamentöse Wirkmechanismen und Studiendaten.
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