ORAL GONADOTROPIN-RELEASING HORMONE ANTAGONISTS IN THE MANAGEMENT OF ENDOMETRIOSIS-ASSOCIATED PAIN: A COMPREHENSIVE REVIEW OF CLINICAL EFFICACY, SAFETY AND SOCIOECONOMIC IMPACT

In: International Journal of Innovative Technologies in Social Science · 2026 · vol. 2(1(49)) · doi:10.31435/ijitss.1(49).2026.4988 · W7139972405
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This review synthesizes clinical data on oral GnRH antagonists for endometriosis-associated pain, evaluating their efficacy, safety, and socioeconomic impact on patients.

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This comprehensive review evaluates oral non-peptide GnRH antagonists—elagolix, relugolix, and linzagolix—for endometriosis-associated pain, synthesizing evidence from major clinical trials (ELARIS, SPIRIT, and SELECT) and related studies on hormonal add-back therapy. It reports that hormonal add-back therapy is an important component for long-term management by helping preserve bone mineral density while maintaining pain suppression, alongside trial findings on clinical efficacy and safety and discussion of patient-reported and socioeconomic impacts such as work productivity and quality of life. The review’s limitations are that it is a narrative synthesis of selected trials and does not provide new primary data, and it frames outcomes through the evidence available in those studies. This paper is centrally about endometriosis — specifically, it reviews the clinical efficacy, safety, and socioeconomic impact of oral GnRH antagonists (elagolix, relugolix, linzagolix) for endometriosis-associated pain.

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Abstract

Endometriosis is a chronic, estrogen-dependent inflammatory disorder that affects approximately 10% of women of reproductive age, resulting in chronic pelvic pain and infertility. The principal clinical challenge is the management of endometriosis-associated pain (EAP), which substantially impairs quality of life and professional productivity. Conventional pharmacological treatments frequently provide inadequate relief or are constrained by significant adverse effects. Elagolix, relugolix, and linzagolix represent a newly developed class of oral non-peptide GnRH antagonists that have recently expanded the therapeutic landscape. Recent studies underscore the essential role of hormonal add-back therapy (ABT) in facilitating long-term management by preserving bone mineral density while suppressing pain. This review synthesizes current clinical data from major trials (ELARIS, SPIRIT, and SELECT) to evaluate the efficacy of these agents and examines their socio-technological impact, specifically how they reduce the socioeconomic burden of the disease and enhance patient autonomy and quality of life.
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ORAL GONADOTROPIN-RELEASING HORMONE ANTAGONISTS IN THE MANAGEMENT OF ENDOMETRIOSIS-ASSOCIATED PAIN: A COMPREHENSIVE REVIEW OF CLINICAL EFFICACY, SAFETY AND SOCIOECONOMIC IMPACT DOI: https://doi.org/10.31435/ijitss.1(49).2026.4988Keywords: Endometriosis, GnRH Antagonists, Elagolix, Relugolix, Linzagolix, Pelvic PainAbstract Endometriosis is a chronic, estrogen-dependent inflammatory disorder that affects approximately 10% of women of reproductive age, resulting in chronic pelvic pain and infertility. The principal clinical challenge is the management of endometriosis-associated pain (EAP), which substantially impairs quality of life and professional productivity. Conventional pharmacological treatments frequently provide inadequate relief or are constrained by significant adverse effects. Elagolix, relugolix, and linzagolix represent a newly developed class of oral non-peptide GnRH antagonists that have recently expanded the therapeutic landscape. Recent studies underscore the essential role of hormonal add-back therapy (ABT) in facilitating long-term management by preserving bone mineral density while suppressing pain. This review synthesizes current clinical data from major trials (ELARIS, SPIRIT, and SELECT) to evaluate the efficacy of these agents and examines their socio-technological impact, specifically how they reduce the socioeconomic burden of the disease and enhance patient autonomy and quality of life. References As-Sanie, S., Black, R., Giudice, L. C., Gray, D. G., Jensen, J. T., Krance, J. P., Williams, A. T., & Soliman, A. M. (2024). The economic and humanistic burden of endometriosis: A systematic review. Journal of Managed Care & Specialty Pharmacy, 30 (2), 112–125. https://doi.org/10.18553/jmcp.2024.30.2.112 Becker, C. M., Bokor, A., Heikinheimo, O., Jawadawy, A., Lukic, A., Murphy, K., Peterson, C., Schultze-Mosgau, M. H., Siebert, U., & Taylor, H. S. (2022). Linzagolix with and without add-back therapy for endometriosis-associated pain: Two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials (SELECT 1 and SELECT 2). The Lancet, 399 (10335), 1643–1655. https://doi.org/10.1016/S0140-6736 (22)00622-0 Donnez, J., Giudice, L. C., Taylor, H. S., Lukes, A. S., Zivny, J. H., Anderson, C., Gay, S. G., Williams, G. C., & Wagman, R. B. (2023). Long-term efficacy and safety of relugolix combination therapy in women with endometriosis-associated pain: 2-year results from the SPIRIT open-label extension study. Human Reproduction, 38 (8), 1512–1524. https://doi.org/10.1093/humrep/dead105 Giudice, L. C., As-Sanie, S., Arjona Ferreira, J. C., Becker, C. M., Abrao, M. S., Lessey, B. A., Brown, E., Sadek, S. J., Wagman, R. B., & Taylor, H. S. (2022). Once-daily oral relugolix combination therapy versus placebo in women with endometriosis-associated pain: Two identical, multicentre, randomised, double-blind, phase 3 trials (SPIRIT 1 and SPIRIT 2). The Lancet, 399 (10343), 2267–2279. https://doi.org/10.1016/S0140-6736 (22)00622-0 Lensen, S., Soliman, A. M., Missmer, S. A., Zito, G., & Taylor, H. S. (2024). Patient-reported outcomes in endometriosis clinical trials: A systematic evaluation of oral GnRH antagonists. Human Reproduction, 39 (1), 45–58. https://doi.org/10.1093/humrep/dead241 Leyland, N., Soliman, A. M., Arjona Ferreira, J. C., & Taylor, H. S. (2024). The impact of oral GnRH antagonists on work productivity and daily activities in women with endometriosis: A real-world evidence synthesis. Journal of Women's Health, 33 (4), 482–491. https://doi.org/10.1089/jwh.2023.0512 Nnoaham, K. E., Hummelshoj, L., Webster, P., d'Hooghe, T., de Cicco Nardone, F., de Cicco Nardone, C., Jenkinson, C., Kennedy, S. H., & Zondervan, K. T. (2011). Impact of endometriosis on quality of life and work productivity: A multicenter study across 10 countries. Fertility and Sterility, 96 (2), 366–373. https://doi.org/10.1016/j.fertnstert.2011.05.090 Osuga, Y., Seki, Y., Tanimoto, M., & Kusumoto, T. (2023). Long-term safety and efficacy of elagolix for endometriosis-associated pain: A comprehensive pharmacological review. Expert Review of Clinical Pharmacology, 16 (11), 1045–1058. https://doi.org/10.1080/17512433.2023.2271036 Simani, L., Taylor, H. S., & Zito, G. (2024). Oral GnRH antagonists for endometriosis: A systematic review and network meta-analysis of clinical efficacy and safety. Fertility and Sterility, 121 (3), 412–425. https://doi.org/10.1016/j.fertnstert.2023.12.015 Taylor, H. S., Giudice, L. C., Lessey, B. A., Abrao, M. S., Kotarski, J., Archer, D. F., Diamond, M. P., Surrey, E. S., Orzeck, N. G., & Watts, N. B. (2017). Treatment of endometriosis-associated pain with elagolix, an oral GnRH antagonist. New England Journal of Medicine, 377 (1), 28–40. https://doi.org/10.1056/NEJMoa1700089 Taylor, H. S., Zito, G., & Simani, L. (2022). Gonadotropin-releasing hormone antagonists for the management of endometriosis: A new era in medical treatment. Journal of Clinical Medicine, 11 (13), 3621. https://doi.org/10.3390/jcm11133621 Vercellini, P., Bracco, B., Mosconi, P., Roberto, A., Alberico, D., & Somigliana, E. (2023). The oral GnRH antagonist era: A new paradigm in the management of endometriosis. Journal of Personalized Medicine, 13 (2), 245. https://doi.org/10.3390/jpm13020245 Zito, G., Simani, L., & Taylor, H. S. (2023). GnRH antagonists for endometriosis: A new era in medical treatment. Diagnostics, 13 (4), 724. https://doi.org/10.3390/diagnostics13040724 Downloads Published Issue Section License Copyright (c) 2026 Maria Kurt, Norbert Gromadzki, Grzegorz Jałoszyński, Sebastian Konecki, Oliwia Marciniak, Natalia Bylak, Bruno Makowski, Maciej Makarewicz, Marcin Patryk Barbachowski, Anna Gwizdek, Dawid Szczepański This work is licensed under a Creative Commons Attribution 4.0 International License. All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles. CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.

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endometriosischronic_pelvic_paininfertility

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