Efficacy and safety of oral gonadotropin-releasing hormone antagonists in moderate-to-severe endometriosis-associated pain: a systematic review and network meta-analysis

Lingli Xin, Yinghao Ma, Mei Ye, Ye Mei, Ling Chen, Fuzhou Liu, Qingxiang Hou
Archives of gynecology and obstetrics · 2023 · vol. 308(4) , pp. 1047–1056 · doi:10.1007/s00404-022-06862-0 · PMID:36656435 · PMC10435625 · W4317477661
review OA: gold CC0 ⤵ 20 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This network meta-analysis found oral GnRH antagonists effective for endometriosis pain, with varying dose-dependent efficacy and safety profiles for different drugs and doses.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This paper conducted a systematic review and network meta-analysis of randomized, placebo-controlled trials (English-language human studies published before April 2022) evaluating oral nonpeptide GnRH antagonists in women with moderate-to-severe endometriosis-associated pain, totaling 2732 patients across 6 double-blind RCTs. The analysis found that elagolix 400 mg and ASP1707 15 mg were most effective for reducing pelvic pain, dysmenorrhea, and dyspareunia, while relugolix 40 mg best reduced analgesic use; however, any TEAEs and TEAE-related discontinuations were highest with relugolix 40 mg and elagolix 250 mg, respectively, with hot flush and headache peaks also differing by dose, and elagolix 250 mg showing significantly decreased spinal BMD. A key caveat is that only 12-week outcomes were synthesized and the number of eligible trials was limited to six comparisons. This paper is centrally about endometriosis — it systematically compares oral GnRH antagonists for moderate-to-severe endometriosis-associated pain efficacy and safety.

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Abstract

PURPOSE: The aim of this NMA is to comprehensively analyze evidence of oral GnRH antagonist in the treatment of moderate-to-severe endometriosis-associated pain. METHODS: Literature searching was performed to select eligible studies published prior to April 2022 in PubMed, Cochrane, Embase and Web of Science. Randomized controlled trials involving patients who suffered from moderate-to-severe endometriosis-associated pain and treated with oral nonpeptide GnRH antagonists or placebo were included. RESULTS: Elagolix 400 mg and ASP1707 15 mg were most efficient in reducing pelvic pain, dysmenorrhea and dyspareunia. Relugolix 40 mg was best in reducing the analgesics use. The rates of any TEAEs and TEAEs-related discontinuation were highest in relugolix 40 mg and elagolix 250 mg, respectively, while rates of hot flush and headache were highest in relugolix 40 mg and elagolix 150 mg. Significantly decreased spinal BMD was observed in elagolix 250 mg. CONCLUSION: Oral GnRH antagonists were effective in endometriosis-associated pain in 12w, and most of the efficiency and safety outcomes were expressed in a dose-dependent manner, but linzagolix 75 mg was an exception.

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Condition tags

endometriosischronic_pelvic_paindysmenorrheadyspareunia

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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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. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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