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VIDEO: Social networking offers coping help for endometriosis patients
VANCOUVER – Nearly half of the discussion topics on the social networking site www.myendometriosisteam.com are about pain, but other uncontrolled symptoms are popular topics, including fatigue and depression.
The online social support network includes 30,000 women with endometriosis and offers them a chance to connect with other women with the condition, find a provider, and research treatments. Elise-Marie Menke, director of alliance management at MyHealthTeams, which runs the site, presented data at the World Congress on Endometriosis. Among the findings she presented was how symptoms mapped to a woman’s cycle.
In a video interview, Ms. Menke described how this type of patient-generated data can play a role in the management of disease and serve to highlight unmet needs to physicians.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
VANCOUVER – Nearly half of the discussion topics on the social networking site www.myendometriosisteam.com are about pain, but other uncontrolled symptoms are popular topics, including fatigue and depression.
The online social support network includes 30,000 women with endometriosis and offers them a chance to connect with other women with the condition, find a provider, and research treatments. Elise-Marie Menke, director of alliance management at MyHealthTeams, which runs the site, presented data at the World Congress on Endometriosis. Among the findings she presented was how symptoms mapped to a woman’s cycle.
In a video interview, Ms. Menke described how this type of patient-generated data can play a role in the management of disease and serve to highlight unmet needs to physicians.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
VANCOUVER – Nearly half of the discussion topics on the social networking site www.myendometriosisteam.com are about pain, but other uncontrolled symptoms are popular topics, including fatigue and depression.
The online social support network includes 30,000 women with endometriosis and offers them a chance to connect with other women with the condition, find a provider, and research treatments. Elise-Marie Menke, director of alliance management at MyHealthTeams, which runs the site, presented data at the World Congress on Endometriosis. Among the findings she presented was how symptoms mapped to a woman’s cycle.
In a video interview, Ms. Menke described how this type of patient-generated data can play a role in the management of disease and serve to highlight unmet needs to physicians.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT WCE 2017
Endometriosis after menopause: Weigh the treatment risks
VANCOUVER – Endometriosis, while generally considered a premenopausal condition, can also occur in women following surgical or natural menopause, and can undergo malignant transformation, although this risk is likely very small.
That was the main message from a new meta-analysis presented at the World Congress on Endometriosis. “We wanted to synthesize the case reports out there to show some common factors so physicians can be aware of them,” said Laura Gemmell, a second-year medical student at Case Western Reserve University, Cleveland, who presented the research.
The researchers surveyed the literature for studies in postmenopausal women with a confirmed or clinically suspected history of endometriosis, and who discussed the management of their menopausal symptoms. They included 33 case reports and case series (42 patients, 36 surgical menopause, 4 natural, 2 presumed natural with later oophorectomy), as well as 6 observational studies and clinical trials.
In the case reports, patients were on HT for a mean of 7.8 years, and 17 of 42 women experienced a recurrence of endometriosis. Also, 25 women had a malignant transformation and there was some overlap with the recurrence group.
Among 17 patients with recurrence, 6 had “severe” or “extensive” endometriosis, and 14 had surgical menopause, with a mean of 7.1 years between surgical menopause and presentation. Twelve of 17 received unopposed estrogen. Following surgical excision (16 of 17 cases), 10 had symptom regression without relapses.
When the researchers looked at the 25 cases of malignant transformation, they found that 13 women had endometriosis at more than one site, 22 had undergone surgical menopause, 19 were on unopposed estrogen, and the mean duration of HT was 6.7 years. Seven women presented with vaginal bleeding and nine with masses. Three died from the disease. These three women had severe endometriosis complicating factors, including older age and multiple malignancies.
The analysis also included six observational studies and clinical trials that explored recurrence of endometriosis, and whether HT should be given to women with a history of endometriosis, whether it should be given immediately after surgical menopause, and the most appropriate menopause treatments.
Predictably, the evidence could not be summed up neatly, but Ms. Gemmell emphasized the need to individually weigh the risks and benefits of HT in each patient, with consideration of characteristics such as age, previous disease severity, family history, comorbidities, and body mass index.
She also suggested that patients should be active participants in decision making.
Finally, if the decision is to go forward or continue with HT, she suggested that clinicians consider a combined treatment rather than estrogen-only, though she pointed out the increased risk for breast cancer that this presents.
Tommaso Falcone, MD, chairman of obstetrics and gynecology at the Cleveland Clinic, sounded a note of caution about the use of progestins during the question-and-answer session. “The data are not strong that it actually prevents the development of cancer in the residual disease, if there is any. Even if you take the hypothesis that progestins are going to prevent cancer of residual disease, which is a low-level risk, the main worry that women have is breast cancer, and progestin is strongly associated with breast cancer,” Dr. Falcone said in an interview.
Ms. Gemmell and Dr. Falcone reported having no financial disclosures.
VANCOUVER – Endometriosis, while generally considered a premenopausal condition, can also occur in women following surgical or natural menopause, and can undergo malignant transformation, although this risk is likely very small.
That was the main message from a new meta-analysis presented at the World Congress on Endometriosis. “We wanted to synthesize the case reports out there to show some common factors so physicians can be aware of them,” said Laura Gemmell, a second-year medical student at Case Western Reserve University, Cleveland, who presented the research.
The researchers surveyed the literature for studies in postmenopausal women with a confirmed or clinically suspected history of endometriosis, and who discussed the management of their menopausal symptoms. They included 33 case reports and case series (42 patients, 36 surgical menopause, 4 natural, 2 presumed natural with later oophorectomy), as well as 6 observational studies and clinical trials.
In the case reports, patients were on HT for a mean of 7.8 years, and 17 of 42 women experienced a recurrence of endometriosis. Also, 25 women had a malignant transformation and there was some overlap with the recurrence group.
Among 17 patients with recurrence, 6 had “severe” or “extensive” endometriosis, and 14 had surgical menopause, with a mean of 7.1 years between surgical menopause and presentation. Twelve of 17 received unopposed estrogen. Following surgical excision (16 of 17 cases), 10 had symptom regression without relapses.
When the researchers looked at the 25 cases of malignant transformation, they found that 13 women had endometriosis at more than one site, 22 had undergone surgical menopause, 19 were on unopposed estrogen, and the mean duration of HT was 6.7 years. Seven women presented with vaginal bleeding and nine with masses. Three died from the disease. These three women had severe endometriosis complicating factors, including older age and multiple malignancies.
The analysis also included six observational studies and clinical trials that explored recurrence of endometriosis, and whether HT should be given to women with a history of endometriosis, whether it should be given immediately after surgical menopause, and the most appropriate menopause treatments.
Predictably, the evidence could not be summed up neatly, but Ms. Gemmell emphasized the need to individually weigh the risks and benefits of HT in each patient, with consideration of characteristics such as age, previous disease severity, family history, comorbidities, and body mass index.
She also suggested that patients should be active participants in decision making.
Finally, if the decision is to go forward or continue with HT, she suggested that clinicians consider a combined treatment rather than estrogen-only, though she pointed out the increased risk for breast cancer that this presents.
Tommaso Falcone, MD, chairman of obstetrics and gynecology at the Cleveland Clinic, sounded a note of caution about the use of progestins during the question-and-answer session. “The data are not strong that it actually prevents the development of cancer in the residual disease, if there is any. Even if you take the hypothesis that progestins are going to prevent cancer of residual disease, which is a low-level risk, the main worry that women have is breast cancer, and progestin is strongly associated with breast cancer,” Dr. Falcone said in an interview.
Ms. Gemmell and Dr. Falcone reported having no financial disclosures.
VANCOUVER – Endometriosis, while generally considered a premenopausal condition, can also occur in women following surgical or natural menopause, and can undergo malignant transformation, although this risk is likely very small.
That was the main message from a new meta-analysis presented at the World Congress on Endometriosis. “We wanted to synthesize the case reports out there to show some common factors so physicians can be aware of them,” said Laura Gemmell, a second-year medical student at Case Western Reserve University, Cleveland, who presented the research.
The researchers surveyed the literature for studies in postmenopausal women with a confirmed or clinically suspected history of endometriosis, and who discussed the management of their menopausal symptoms. They included 33 case reports and case series (42 patients, 36 surgical menopause, 4 natural, 2 presumed natural with later oophorectomy), as well as 6 observational studies and clinical trials.
In the case reports, patients were on HT for a mean of 7.8 years, and 17 of 42 women experienced a recurrence of endometriosis. Also, 25 women had a malignant transformation and there was some overlap with the recurrence group.
Among 17 patients with recurrence, 6 had “severe” or “extensive” endometriosis, and 14 had surgical menopause, with a mean of 7.1 years between surgical menopause and presentation. Twelve of 17 received unopposed estrogen. Following surgical excision (16 of 17 cases), 10 had symptom regression without relapses.
When the researchers looked at the 25 cases of malignant transformation, they found that 13 women had endometriosis at more than one site, 22 had undergone surgical menopause, 19 were on unopposed estrogen, and the mean duration of HT was 6.7 years. Seven women presented with vaginal bleeding and nine with masses. Three died from the disease. These three women had severe endometriosis complicating factors, including older age and multiple malignancies.
The analysis also included six observational studies and clinical trials that explored recurrence of endometriosis, and whether HT should be given to women with a history of endometriosis, whether it should be given immediately after surgical menopause, and the most appropriate menopause treatments.
Predictably, the evidence could not be summed up neatly, but Ms. Gemmell emphasized the need to individually weigh the risks and benefits of HT in each patient, with consideration of characteristics such as age, previous disease severity, family history, comorbidities, and body mass index.
She also suggested that patients should be active participants in decision making.
Finally, if the decision is to go forward or continue with HT, she suggested that clinicians consider a combined treatment rather than estrogen-only, though she pointed out the increased risk for breast cancer that this presents.
Tommaso Falcone, MD, chairman of obstetrics and gynecology at the Cleveland Clinic, sounded a note of caution about the use of progestins during the question-and-answer session. “The data are not strong that it actually prevents the development of cancer in the residual disease, if there is any. Even if you take the hypothesis that progestins are going to prevent cancer of residual disease, which is a low-level risk, the main worry that women have is breast cancer, and progestin is strongly associated with breast cancer,” Dr. Falcone said in an interview.
Ms. Gemmell and Dr. Falcone reported having no financial disclosures.
EXPERT ANALYSIS AT WCE 2017
Elastrographic ultrasound could guide adenomyosis treatment
VANCOUVER – Transvaginal elastrographic (TVEG) ultrasound appears to be a better way to diagnose adenomyosis, outperforming transvaginal ultrasound in identifying lesions, according to new findings.
Researchers at Fudan University in Shanghai compared TVEG results in 152 women with adenomyosis, 89 women with fibroids, and 136 healthy controls. None of the women had received hormone therapy in the previous 6 months. Imaging was performed with both TVEG and transvaginal ultrasound, and tissue samples were taken to test for estrogen receptor (ER)-beta, progesterone receptor (PR), epithelial cadherin, and alpha–smooth muscle actin (SMA).
Image analysis showed that TVEG readily distinguished adenomyosis from fibroids or normal uterine tissue. The elastic value, representing stiffness, was highest in adenomyosis patients (3.74 plus or minus 1.01, P less than .001), followed by fibrosis (2.87 plus or minus 0.74; P less than .001), and normal tissue (1.43 plus or minus 0.59).
Elastic values correlated positively to the extent of fibrosis (r = 0.91; P less than .001), and staining levels of alpha-SMA and ER-beta (r = 0.84; P less than .001). Elasticity correlated negatively with epithelial cadherin and PR (r = –0.86; P less than .001).
The researchers concluded that TVEG outperforms transvaginal ultrasound in diagnosing adenomyosis, and that the close correlation between measurements of stiffness and fibrosis and hormone response markers suggests that it could one day help physicians choose between hormone therapy and hysterectomy.
“If we find more elastic values, maybe that means there is more fibrosis in the lesion, and it may be not as sensitive to hormone treatment, so maybe we should move on to hysterectomy,” Ding Ding, MD, PhD, associate professor of gynecology at Fudan University, said at the World Congress on Endometriosis.
But the current research does not provide those answers yet, since the elastic values weren’t linked to a clinical outcome. “We want to verify in the next step, in women who have higher elastic values, whether they are sensitive to progesterone treatment,” Dr. Ding said.
The study was sponsored by the Chinese government. Dr. Ding reported having no financial disclosures.
VANCOUVER – Transvaginal elastrographic (TVEG) ultrasound appears to be a better way to diagnose adenomyosis, outperforming transvaginal ultrasound in identifying lesions, according to new findings.
Researchers at Fudan University in Shanghai compared TVEG results in 152 women with adenomyosis, 89 women with fibroids, and 136 healthy controls. None of the women had received hormone therapy in the previous 6 months. Imaging was performed with both TVEG and transvaginal ultrasound, and tissue samples were taken to test for estrogen receptor (ER)-beta, progesterone receptor (PR), epithelial cadherin, and alpha–smooth muscle actin (SMA).
Image analysis showed that TVEG readily distinguished adenomyosis from fibroids or normal uterine tissue. The elastic value, representing stiffness, was highest in adenomyosis patients (3.74 plus or minus 1.01, P less than .001), followed by fibrosis (2.87 plus or minus 0.74; P less than .001), and normal tissue (1.43 plus or minus 0.59).
Elastic values correlated positively to the extent of fibrosis (r = 0.91; P less than .001), and staining levels of alpha-SMA and ER-beta (r = 0.84; P less than .001). Elasticity correlated negatively with epithelial cadherin and PR (r = –0.86; P less than .001).
The researchers concluded that TVEG outperforms transvaginal ultrasound in diagnosing adenomyosis, and that the close correlation between measurements of stiffness and fibrosis and hormone response markers suggests that it could one day help physicians choose between hormone therapy and hysterectomy.
“If we find more elastic values, maybe that means there is more fibrosis in the lesion, and it may be not as sensitive to hormone treatment, so maybe we should move on to hysterectomy,” Ding Ding, MD, PhD, associate professor of gynecology at Fudan University, said at the World Congress on Endometriosis.
But the current research does not provide those answers yet, since the elastic values weren’t linked to a clinical outcome. “We want to verify in the next step, in women who have higher elastic values, whether they are sensitive to progesterone treatment,” Dr. Ding said.
The study was sponsored by the Chinese government. Dr. Ding reported having no financial disclosures.
VANCOUVER – Transvaginal elastrographic (TVEG) ultrasound appears to be a better way to diagnose adenomyosis, outperforming transvaginal ultrasound in identifying lesions, according to new findings.
Researchers at Fudan University in Shanghai compared TVEG results in 152 women with adenomyosis, 89 women with fibroids, and 136 healthy controls. None of the women had received hormone therapy in the previous 6 months. Imaging was performed with both TVEG and transvaginal ultrasound, and tissue samples were taken to test for estrogen receptor (ER)-beta, progesterone receptor (PR), epithelial cadherin, and alpha–smooth muscle actin (SMA).
Image analysis showed that TVEG readily distinguished adenomyosis from fibroids or normal uterine tissue. The elastic value, representing stiffness, was highest in adenomyosis patients (3.74 plus or minus 1.01, P less than .001), followed by fibrosis (2.87 plus or minus 0.74; P less than .001), and normal tissue (1.43 plus or minus 0.59).
Elastic values correlated positively to the extent of fibrosis (r = 0.91; P less than .001), and staining levels of alpha-SMA and ER-beta (r = 0.84; P less than .001). Elasticity correlated negatively with epithelial cadherin and PR (r = –0.86; P less than .001).
The researchers concluded that TVEG outperforms transvaginal ultrasound in diagnosing adenomyosis, and that the close correlation between measurements of stiffness and fibrosis and hormone response markers suggests that it could one day help physicians choose between hormone therapy and hysterectomy.
“If we find more elastic values, maybe that means there is more fibrosis in the lesion, and it may be not as sensitive to hormone treatment, so maybe we should move on to hysterectomy,” Ding Ding, MD, PhD, associate professor of gynecology at Fudan University, said at the World Congress on Endometriosis.
But the current research does not provide those answers yet, since the elastic values weren’t linked to a clinical outcome. “We want to verify in the next step, in women who have higher elastic values, whether they are sensitive to progesterone treatment,” Dr. Ding said.
The study was sponsored by the Chinese government. Dr. Ding reported having no financial disclosures.
AT WCE 2017
Key clinical point:
Major finding: Elastic values correlated with fibrosis (r = 0.91), alpha-SMA and ER-beta (r = 0.84), and epithelial cadherin and PR (r = –0.86).
Data source: Prospective case-controlled study of 152 women with adenomyosis, 89 with fibroids, and 136 controls.
Disclosures: The study was sponsored by the Chinese government. Dr. Ding reported having no financial disclosures.
Study validates endometriosis fertility index
VANCOUVER – The Endometriosis Fertility Index accurately predicts a woman’s chances to conceive naturally with endometriosis, according to findings from a prospective cohort study.
“We’re quite confident that this is a very good system to give women a reasonable idea of their chances of conceiving naturally versus a recommendation to have IVF,” Aaron Budden, Bmed, Mmed, of the Royal Hospital for Women in Sydney, said at the World Congress on Endometriosis.
The Endometriosis Fertility Index (EFI) was first published in 2010 (Fertil Steril. 2010 Oct;94[5]:1609-15). In the recent study, researchers found that live birth rates after 3 years closely matched the rates calculated by the tool. “This is one of the most useful systems I’ve ever seen, because it takes into account historical events, as well as the time of endometriosis surgery,” Dr. Budden said.
The researchers enrolled 141 consecutive women who had undergone fertility-saving laparoscopic excision of stage III or stage IV endometriosis and attempted to conceive naturally. During follow-up, the researchers contacted the patients to determine live births, and calculated the EFI score based on a woman’s age, duration of infertility, previous pregnancy, American Society for Reproductive Medicine endometriosis classification, and their least adnexal function score. “The least function score is based off the functional capacity of the fallopian tube, fimbriae, and ovary, where the score is calculated by which of these is least functional on both right and left side,” Dr. Budden said.
The researchers included women with stage III and stage IV endometriosis because this group is often referred for in vitro fertilization (IVF). “But we found that in women with an advanced stage of endometriosis, those with EFI scores of 9 and 10 still had quite a significant chance of conceiving at 3 years, compared to women who had EFI scores of 0 to 2,” Dr. Budden said.
More than a third of the women (35%) had stage III endometriosis, and 65% had stage IV. The mean follow-up period was 56 months. Overall, 46% achieved live births.
In women with an EFI score of 9-10, the success rate was 67% at 3 years. Nearly half (48%) of women with scores of 7-8 were successful at 3 years, as were 38% with scores of 5-6, and 17% with scores of 3-4. Among women with scores of 0-2, there were no live births at 3 years.
About 58% of the women in the study had undergone previous laparoscopic surgery. The researchers found that live births were associated with complete resection of disease (hazard ratio, 2.33; P = .036) and no previous laparoscopy (HR, 2.36; P less than .001).
“One of the things we have to say is that your best chance at conceiving is if you excise all the endometriosis and you do it the first time, rather than needing a second surgery,” Dr. Budden said.
The tool can also be used to help identify patients most likely to benefit from assisted reproduction. Women with EFI scores of 0-2 had a 0% chance of conceiving naturally when followed out to 5 years, but a 39% chance with IVF. “That’s a group that you would thoroughly recommend going to IVF rather than trying to conceive naturally,” Dr. Budden said in an interview.
The study was funded by a variety of non-industry sources. Dr. Budden reported having no financial disclosures.
VANCOUVER – The Endometriosis Fertility Index accurately predicts a woman’s chances to conceive naturally with endometriosis, according to findings from a prospective cohort study.
“We’re quite confident that this is a very good system to give women a reasonable idea of their chances of conceiving naturally versus a recommendation to have IVF,” Aaron Budden, Bmed, Mmed, of the Royal Hospital for Women in Sydney, said at the World Congress on Endometriosis.
The Endometriosis Fertility Index (EFI) was first published in 2010 (Fertil Steril. 2010 Oct;94[5]:1609-15). In the recent study, researchers found that live birth rates after 3 years closely matched the rates calculated by the tool. “This is one of the most useful systems I’ve ever seen, because it takes into account historical events, as well as the time of endometriosis surgery,” Dr. Budden said.
The researchers enrolled 141 consecutive women who had undergone fertility-saving laparoscopic excision of stage III or stage IV endometriosis and attempted to conceive naturally. During follow-up, the researchers contacted the patients to determine live births, and calculated the EFI score based on a woman’s age, duration of infertility, previous pregnancy, American Society for Reproductive Medicine endometriosis classification, and their least adnexal function score. “The least function score is based off the functional capacity of the fallopian tube, fimbriae, and ovary, where the score is calculated by which of these is least functional on both right and left side,” Dr. Budden said.
The researchers included women with stage III and stage IV endometriosis because this group is often referred for in vitro fertilization (IVF). “But we found that in women with an advanced stage of endometriosis, those with EFI scores of 9 and 10 still had quite a significant chance of conceiving at 3 years, compared to women who had EFI scores of 0 to 2,” Dr. Budden said.
More than a third of the women (35%) had stage III endometriosis, and 65% had stage IV. The mean follow-up period was 56 months. Overall, 46% achieved live births.
In women with an EFI score of 9-10, the success rate was 67% at 3 years. Nearly half (48%) of women with scores of 7-8 were successful at 3 years, as were 38% with scores of 5-6, and 17% with scores of 3-4. Among women with scores of 0-2, there were no live births at 3 years.
About 58% of the women in the study had undergone previous laparoscopic surgery. The researchers found that live births were associated with complete resection of disease (hazard ratio, 2.33; P = .036) and no previous laparoscopy (HR, 2.36; P less than .001).
“One of the things we have to say is that your best chance at conceiving is if you excise all the endometriosis and you do it the first time, rather than needing a second surgery,” Dr. Budden said.
The tool can also be used to help identify patients most likely to benefit from assisted reproduction. Women with EFI scores of 0-2 had a 0% chance of conceiving naturally when followed out to 5 years, but a 39% chance with IVF. “That’s a group that you would thoroughly recommend going to IVF rather than trying to conceive naturally,” Dr. Budden said in an interview.
The study was funded by a variety of non-industry sources. Dr. Budden reported having no financial disclosures.
VANCOUVER – The Endometriosis Fertility Index accurately predicts a woman’s chances to conceive naturally with endometriosis, according to findings from a prospective cohort study.
“We’re quite confident that this is a very good system to give women a reasonable idea of their chances of conceiving naturally versus a recommendation to have IVF,” Aaron Budden, Bmed, Mmed, of the Royal Hospital for Women in Sydney, said at the World Congress on Endometriosis.
The Endometriosis Fertility Index (EFI) was first published in 2010 (Fertil Steril. 2010 Oct;94[5]:1609-15). In the recent study, researchers found that live birth rates after 3 years closely matched the rates calculated by the tool. “This is one of the most useful systems I’ve ever seen, because it takes into account historical events, as well as the time of endometriosis surgery,” Dr. Budden said.
The researchers enrolled 141 consecutive women who had undergone fertility-saving laparoscopic excision of stage III or stage IV endometriosis and attempted to conceive naturally. During follow-up, the researchers contacted the patients to determine live births, and calculated the EFI score based on a woman’s age, duration of infertility, previous pregnancy, American Society for Reproductive Medicine endometriosis classification, and their least adnexal function score. “The least function score is based off the functional capacity of the fallopian tube, fimbriae, and ovary, where the score is calculated by which of these is least functional on both right and left side,” Dr. Budden said.
The researchers included women with stage III and stage IV endometriosis because this group is often referred for in vitro fertilization (IVF). “But we found that in women with an advanced stage of endometriosis, those with EFI scores of 9 and 10 still had quite a significant chance of conceiving at 3 years, compared to women who had EFI scores of 0 to 2,” Dr. Budden said.
More than a third of the women (35%) had stage III endometriosis, and 65% had stage IV. The mean follow-up period was 56 months. Overall, 46% achieved live births.
In women with an EFI score of 9-10, the success rate was 67% at 3 years. Nearly half (48%) of women with scores of 7-8 were successful at 3 years, as were 38% with scores of 5-6, and 17% with scores of 3-4. Among women with scores of 0-2, there were no live births at 3 years.
About 58% of the women in the study had undergone previous laparoscopic surgery. The researchers found that live births were associated with complete resection of disease (hazard ratio, 2.33; P = .036) and no previous laparoscopy (HR, 2.36; P less than .001).
“One of the things we have to say is that your best chance at conceiving is if you excise all the endometriosis and you do it the first time, rather than needing a second surgery,” Dr. Budden said.
The tool can also be used to help identify patients most likely to benefit from assisted reproduction. Women with EFI scores of 0-2 had a 0% chance of conceiving naturally when followed out to 5 years, but a 39% chance with IVF. “That’s a group that you would thoroughly recommend going to IVF rather than trying to conceive naturally,” Dr. Budden said in an interview.
The study was funded by a variety of non-industry sources. Dr. Budden reported having no financial disclosures.
AT WCE 2017
Key clinical point:
Major finding: Women who scored 9-10 on the EFI had a 67% live birth rate at 3 years without IVF.
Data source: Prospective analysis of 141 women in Australia.
Disclosures: The study was funded by a variety of non-industry sources. Dr. Budden reported having no financial disclosures.
Endometriosis detection by microRNA possible in early stages
VANCOUVER – A panel of 11 microRNA biomarkers was effective in predicting endometriosis in a small validation study conducted at a Belgium hospital, showing the progress researchers are making toward a noninvasive test.
The research team at Leuven University Hospital developed the model using a population of 120 women, 82 of whom had endometriosis. After extensive analysis, they identified 11 microRNAs, which varied significantly between endometriosis patients and healthy controls and could be used as part of a panel to detect endometriosis. The panel performed well in their validation sample of 60 women with endometriosis and 30 controls, with a sensitivity of 92% and a specificity of 96%.
That validation is good news, but it is still far from being clinically useful. First, the model needs to be tested further in their own predominantly Caucasian population. Then, it needs to be validated by outside researchers, and the model will almost certainly have to be altered to account for different genetic backgrounds, lifestyle habits, and other factors, Arne Vanhie, MD, of Leuven University Hospital said at the World Congress on Endometriosis.
“We may have to tweak it a bit,” he said.
Unfortunately, that tweaking is likely to be time consuming. That’s because RNA extraction and sequencing is labor intensive and expensive, though it could be readily automated if it becomes commercialized.
It’s also technically challenging because microRNA is present in very low concentrations in plasma so researchers must spot a rare signal surrounded by a sea of noise, and that can mean a lot of technical refinement along the way. “We did a lot of testing and trial and error to see what was the best protocol,” Dr. Vanhie said.
The news isn’t all bad. With a well-funded, intensive effort, development could be swift. “There’s no intervention. You just need a tube of blood, so you could go forward with this to make it clinically relevant very easily,” Dr. Vanhie said.
The study was sponsored by the Belgian government. Dr. Vanhie reported having no financial disclosures.
VANCOUVER – A panel of 11 microRNA biomarkers was effective in predicting endometriosis in a small validation study conducted at a Belgium hospital, showing the progress researchers are making toward a noninvasive test.
The research team at Leuven University Hospital developed the model using a population of 120 women, 82 of whom had endometriosis. After extensive analysis, they identified 11 microRNAs, which varied significantly between endometriosis patients and healthy controls and could be used as part of a panel to detect endometriosis. The panel performed well in their validation sample of 60 women with endometriosis and 30 controls, with a sensitivity of 92% and a specificity of 96%.
That validation is good news, but it is still far from being clinically useful. First, the model needs to be tested further in their own predominantly Caucasian population. Then, it needs to be validated by outside researchers, and the model will almost certainly have to be altered to account for different genetic backgrounds, lifestyle habits, and other factors, Arne Vanhie, MD, of Leuven University Hospital said at the World Congress on Endometriosis.
“We may have to tweak it a bit,” he said.
Unfortunately, that tweaking is likely to be time consuming. That’s because RNA extraction and sequencing is labor intensive and expensive, though it could be readily automated if it becomes commercialized.
It’s also technically challenging because microRNA is present in very low concentrations in plasma so researchers must spot a rare signal surrounded by a sea of noise, and that can mean a lot of technical refinement along the way. “We did a lot of testing and trial and error to see what was the best protocol,” Dr. Vanhie said.
The news isn’t all bad. With a well-funded, intensive effort, development could be swift. “There’s no intervention. You just need a tube of blood, so you could go forward with this to make it clinically relevant very easily,” Dr. Vanhie said.
The study was sponsored by the Belgian government. Dr. Vanhie reported having no financial disclosures.
VANCOUVER – A panel of 11 microRNA biomarkers was effective in predicting endometriosis in a small validation study conducted at a Belgium hospital, showing the progress researchers are making toward a noninvasive test.
The research team at Leuven University Hospital developed the model using a population of 120 women, 82 of whom had endometriosis. After extensive analysis, they identified 11 microRNAs, which varied significantly between endometriosis patients and healthy controls and could be used as part of a panel to detect endometriosis. The panel performed well in their validation sample of 60 women with endometriosis and 30 controls, with a sensitivity of 92% and a specificity of 96%.
That validation is good news, but it is still far from being clinically useful. First, the model needs to be tested further in their own predominantly Caucasian population. Then, it needs to be validated by outside researchers, and the model will almost certainly have to be altered to account for different genetic backgrounds, lifestyle habits, and other factors, Arne Vanhie, MD, of Leuven University Hospital said at the World Congress on Endometriosis.
“We may have to tweak it a bit,” he said.
Unfortunately, that tweaking is likely to be time consuming. That’s because RNA extraction and sequencing is labor intensive and expensive, though it could be readily automated if it becomes commercialized.
It’s also technically challenging because microRNA is present in very low concentrations in plasma so researchers must spot a rare signal surrounded by a sea of noise, and that can mean a lot of technical refinement along the way. “We did a lot of testing and trial and error to see what was the best protocol,” Dr. Vanhie said.
The news isn’t all bad. With a well-funded, intensive effort, development could be swift. “There’s no intervention. You just need a tube of blood, so you could go forward with this to make it clinically relevant very easily,” Dr. Vanhie said.
The study was sponsored by the Belgian government. Dr. Vanhie reported having no financial disclosures.
AT WCE 2017
Key clinical point:
Major finding: The panel detected endometriosis with 92% sensitivity and 96% specificity.
Data source: The development sample included 120 women and a validation group of 90 women.
Disclosures: The study was sponsored by the Belgian government. Dr. Vanhie reported having no financial disclosures.
Ulipristal acetate: A new option for endometriosis pain?
VANCOUVER – Not too long ago, clinicians at McMaster University in Hamilton, Ont., noticed that ulipristal acetate seemed to reduce pelvic pain in women who were taking it to shrink fibroids and reduce bleeding and other symptoms.
Fibroids aren’t usually painful, however, so they had a hunch it was helping with pain from other causes and decided to take a closer look.
All of the women at McMaster started out with moderate to severe pelvic pain, but ,while on the drug, nine (50%) said they had less pain, and seven (39%) said they had no pain at all. Most of the women reduced or stopped other pain medications.
Ten of the women had surgery, generally for fibroid control, and nine turned out to have endometriosis, adenomyosis, or both. The women were 25-49 years old and took the drug per Canadian fibroid labeling – 5 mg daily for 3 months.
“I was surprised by how many women actually had an improvement in their pain and how many went down to zero,” said lead investigator Sarah Scattolon, MD, a minimally invasive gynecologic surgery fellow at McMaster. Almost all of the women “had used multiple treatments in the past that didn’t work, including opioids. That makes a placebo effect less likely.”
The need for better endometriosis treatments was a frequent topic at the World Congress on Endometriosis, where Dr. Scattolon presented the study findings. Gonadotropin-releasing hormone agonists, progestins, and other options can help, but they don’t work for everyone, and some women can’t tolerate the side effects.
The idea that ulipristal acetate and other selective progesterone receptor modulators might be useful additions to the armamentarium has been around for a while, but there’s not much research. Dr. Scattolon said her next step is a prospective study among women with pelvic pain and, ultimately, a randomized trial. A small prospective study is already underway at Northwestern University, Chicago, for pelvic pain associated with endometriosis.
It’s unclear how the drug helps pelvic pain. It suppresses ovulation, which might help women with pain related to menstruation. “It presumably works in a different way” than other anovulatory options, Dr. Scattolon said.
Hot flashes and headaches are the most common adverse reactions, but Allergan’s Canadian Fibristal monograph states that side effects are mild or moderate and do not often lead to discontinuation.
Allergan wasn’t involved in the study, but Dr. Scattolon was scheduled to give her first paid talk for the company.
VANCOUVER – Not too long ago, clinicians at McMaster University in Hamilton, Ont., noticed that ulipristal acetate seemed to reduce pelvic pain in women who were taking it to shrink fibroids and reduce bleeding and other symptoms.
Fibroids aren’t usually painful, however, so they had a hunch it was helping with pain from other causes and decided to take a closer look.
All of the women at McMaster started out with moderate to severe pelvic pain, but ,while on the drug, nine (50%) said they had less pain, and seven (39%) said they had no pain at all. Most of the women reduced or stopped other pain medications.
Ten of the women had surgery, generally for fibroid control, and nine turned out to have endometriosis, adenomyosis, or both. The women were 25-49 years old and took the drug per Canadian fibroid labeling – 5 mg daily for 3 months.
“I was surprised by how many women actually had an improvement in their pain and how many went down to zero,” said lead investigator Sarah Scattolon, MD, a minimally invasive gynecologic surgery fellow at McMaster. Almost all of the women “had used multiple treatments in the past that didn’t work, including opioids. That makes a placebo effect less likely.”
The need for better endometriosis treatments was a frequent topic at the World Congress on Endometriosis, where Dr. Scattolon presented the study findings. Gonadotropin-releasing hormone agonists, progestins, and other options can help, but they don’t work for everyone, and some women can’t tolerate the side effects.
The idea that ulipristal acetate and other selective progesterone receptor modulators might be useful additions to the armamentarium has been around for a while, but there’s not much research. Dr. Scattolon said her next step is a prospective study among women with pelvic pain and, ultimately, a randomized trial. A small prospective study is already underway at Northwestern University, Chicago, for pelvic pain associated with endometriosis.
It’s unclear how the drug helps pelvic pain. It suppresses ovulation, which might help women with pain related to menstruation. “It presumably works in a different way” than other anovulatory options, Dr. Scattolon said.
Hot flashes and headaches are the most common adverse reactions, but Allergan’s Canadian Fibristal monograph states that side effects are mild or moderate and do not often lead to discontinuation.
Allergan wasn’t involved in the study, but Dr. Scattolon was scheduled to give her first paid talk for the company.
VANCOUVER – Not too long ago, clinicians at McMaster University in Hamilton, Ont., noticed that ulipristal acetate seemed to reduce pelvic pain in women who were taking it to shrink fibroids and reduce bleeding and other symptoms.
Fibroids aren’t usually painful, however, so they had a hunch it was helping with pain from other causes and decided to take a closer look.
All of the women at McMaster started out with moderate to severe pelvic pain, but ,while on the drug, nine (50%) said they had less pain, and seven (39%) said they had no pain at all. Most of the women reduced or stopped other pain medications.
Ten of the women had surgery, generally for fibroid control, and nine turned out to have endometriosis, adenomyosis, or both. The women were 25-49 years old and took the drug per Canadian fibroid labeling – 5 mg daily for 3 months.
“I was surprised by how many women actually had an improvement in their pain and how many went down to zero,” said lead investigator Sarah Scattolon, MD, a minimally invasive gynecologic surgery fellow at McMaster. Almost all of the women “had used multiple treatments in the past that didn’t work, including opioids. That makes a placebo effect less likely.”
The need for better endometriosis treatments was a frequent topic at the World Congress on Endometriosis, where Dr. Scattolon presented the study findings. Gonadotropin-releasing hormone agonists, progestins, and other options can help, but they don’t work for everyone, and some women can’t tolerate the side effects.
The idea that ulipristal acetate and other selective progesterone receptor modulators might be useful additions to the armamentarium has been around for a while, but there’s not much research. Dr. Scattolon said her next step is a prospective study among women with pelvic pain and, ultimately, a randomized trial. A small prospective study is already underway at Northwestern University, Chicago, for pelvic pain associated with endometriosis.
It’s unclear how the drug helps pelvic pain. It suppresses ovulation, which might help women with pain related to menstruation. “It presumably works in a different way” than other anovulatory options, Dr. Scattolon said.
Hot flashes and headaches are the most common adverse reactions, but Allergan’s Canadian Fibristal monograph states that side effects are mild or moderate and do not often lead to discontinuation.
Allergan wasn’t involved in the study, but Dr. Scattolon was scheduled to give her first paid talk for the company.
AT WCE 2017
Key clinical point:
Major finding: Of 18 women with moderate-to-severe pelvic pain, 9 (50%) noted less pain while on ulipristal acetate for fibroids, and 7 (39%) said they had no pain at all.
Data source: A chart review of 18 women.
Disclosures: Allergan, the drug’s maker, wasn’t involved in the study, but the lead investigator was scheduled to give her first paid talk for the company.
Biomarker panel promising for early endometriosis diagnosis
VANCOUVER – Investigators at McMaster University in Hamilton, Ontario, are zeroing in on a biomarker blood test panel to diagnose endometriosis without surgery.
At the World Congress on Endometriosis, they described a decision tree incorporating blood levels of brain-derived neurotrophic factor (BDNF), glycodelin, and zinc-alpha2-glycoprotein (ZAG), quantified by enzyme-linked immunosorbent assay. ZAG levels above 91.58 ng/mL – the first cut in the decision tree, glycodelin above 39.19 ng/mL – the second cut, and BDNF above 953.9 pg/mL identified endometriosis with a sensitivity of 89.2% and a specificity of 70.0%. The combination outperformed any biomarker on its own.
BDNF is a protein involved in neurogenesis, angiogenesis, and apoptosis resistance, all hallmark pathogenic features of endometriosis. Glycodelin and ZAG are associated with secretory endometrium.
The findings come from a comparison of blood levels in 65 women undergoing endometriosis surgery with the blood levels in 14 women undergoing surgery for benign gynecological problems, and in 16 healthy controls with no history of pelvic pain.
The need is great for a noninvasive test to diagnose endometriosis. Currently, diagnosis is made during surgery and can be delayed for several years. Like investigators at other institutions, the research team at McMaster is hoping to develop an easy, accurate way to catch and treat the disease early before complications set in.
Early diagnosis has “resisted our best efforts for years, but we are slowly moving closer to the end zone,” said senior investigator Warren Foster, PhD, a professor of obstetrics and gynecology at McMaster.
Other teams have reported favorable results for microRNAs, circulating endometrial stem cells, biomarker combinations, and other approaches. “It seems to me that there is a lot of progress being made. One of the big issues that we still have to solve is reproducibility, but there’s so much coming forward,” Dr. Foster said. “It’s an exciting time to be looking for novel diagnostic markers for endometriosis.”
The McMaster team next plans to test its panel prospectively in women with suspected early stage disease.
The work was funded by the Canadian Institutes of Health Research. Dr. Foster is in talks with industry to license the algorithm.
VANCOUVER – Investigators at McMaster University in Hamilton, Ontario, are zeroing in on a biomarker blood test panel to diagnose endometriosis without surgery.
At the World Congress on Endometriosis, they described a decision tree incorporating blood levels of brain-derived neurotrophic factor (BDNF), glycodelin, and zinc-alpha2-glycoprotein (ZAG), quantified by enzyme-linked immunosorbent assay. ZAG levels above 91.58 ng/mL – the first cut in the decision tree, glycodelin above 39.19 ng/mL – the second cut, and BDNF above 953.9 pg/mL identified endometriosis with a sensitivity of 89.2% and a specificity of 70.0%. The combination outperformed any biomarker on its own.
BDNF is a protein involved in neurogenesis, angiogenesis, and apoptosis resistance, all hallmark pathogenic features of endometriosis. Glycodelin and ZAG are associated with secretory endometrium.
The findings come from a comparison of blood levels in 65 women undergoing endometriosis surgery with the blood levels in 14 women undergoing surgery for benign gynecological problems, and in 16 healthy controls with no history of pelvic pain.
The need is great for a noninvasive test to diagnose endometriosis. Currently, diagnosis is made during surgery and can be delayed for several years. Like investigators at other institutions, the research team at McMaster is hoping to develop an easy, accurate way to catch and treat the disease early before complications set in.
Early diagnosis has “resisted our best efforts for years, but we are slowly moving closer to the end zone,” said senior investigator Warren Foster, PhD, a professor of obstetrics and gynecology at McMaster.
Other teams have reported favorable results for microRNAs, circulating endometrial stem cells, biomarker combinations, and other approaches. “It seems to me that there is a lot of progress being made. One of the big issues that we still have to solve is reproducibility, but there’s so much coming forward,” Dr. Foster said. “It’s an exciting time to be looking for novel diagnostic markers for endometriosis.”
The McMaster team next plans to test its panel prospectively in women with suspected early stage disease.
The work was funded by the Canadian Institutes of Health Research. Dr. Foster is in talks with industry to license the algorithm.
VANCOUVER – Investigators at McMaster University in Hamilton, Ontario, are zeroing in on a biomarker blood test panel to diagnose endometriosis without surgery.
At the World Congress on Endometriosis, they described a decision tree incorporating blood levels of brain-derived neurotrophic factor (BDNF), glycodelin, and zinc-alpha2-glycoprotein (ZAG), quantified by enzyme-linked immunosorbent assay. ZAG levels above 91.58 ng/mL – the first cut in the decision tree, glycodelin above 39.19 ng/mL – the second cut, and BDNF above 953.9 pg/mL identified endometriosis with a sensitivity of 89.2% and a specificity of 70.0%. The combination outperformed any biomarker on its own.
BDNF is a protein involved in neurogenesis, angiogenesis, and apoptosis resistance, all hallmark pathogenic features of endometriosis. Glycodelin and ZAG are associated with secretory endometrium.
The findings come from a comparison of blood levels in 65 women undergoing endometriosis surgery with the blood levels in 14 women undergoing surgery for benign gynecological problems, and in 16 healthy controls with no history of pelvic pain.
The need is great for a noninvasive test to diagnose endometriosis. Currently, diagnosis is made during surgery and can be delayed for several years. Like investigators at other institutions, the research team at McMaster is hoping to develop an easy, accurate way to catch and treat the disease early before complications set in.
Early diagnosis has “resisted our best efforts for years, but we are slowly moving closer to the end zone,” said senior investigator Warren Foster, PhD, a professor of obstetrics and gynecology at McMaster.
Other teams have reported favorable results for microRNAs, circulating endometrial stem cells, biomarker combinations, and other approaches. “It seems to me that there is a lot of progress being made. One of the big issues that we still have to solve is reproducibility, but there’s so much coming forward,” Dr. Foster said. “It’s an exciting time to be looking for novel diagnostic markers for endometriosis.”
The McMaster team next plans to test its panel prospectively in women with suspected early stage disease.
The work was funded by the Canadian Institutes of Health Research. Dr. Foster is in talks with industry to license the algorithm.
AT WCE 2017
Key clinical point:
Major finding: Zinc-alpha2-glycoprotein levels above 91.58 ng/mL, glycodelin above 39.19 ng/mL, and brain-derived neurotrophic factor above 953.30 pg/mL identified endometriosis with a sensitivity of 89.2% and a specificity of 70.0%.
Data source: A case-control review of 95 women.
Disclosures: The work was funded by the Canadian Institutes of Health Research. The investigators are in talks with industry to license the algorithm.
VIDEO: School program aims to cut diagnostic delay in endometriosis
VANCOUVER – Although symptoms can start young in endometriosis – sometimes in adolescence – women often suffer for years from bowel problems, pain, dyspareunia, and other complications before the condition is recognized and addressed.
Endometriosis can be “a monster of a disease,” especially if it’s not recognized early, said Deborah Bush, cofounder and CEO of the patient advocacy group Endometriosis New Zealand.
To help, she and her colleagues started an education program in New Zealand to teach secondary school students how to recognize – and seek help – when menstrual symptoms fall outside the norm.
In an interview at the World Congress on Endometriosis, Ms. Bush explained the importance of such efforts, and the impact they’ve had in New Zealand over the past 20 years (Aust N Z J Obstet Gynaecol. 2017 Mar 28. doi: 10.1111/ajo.12614).
She also gave an example from her own endometriosis consulting practice of what it took to turn around a patient who had been suffering with the disease for 15 years. Treatment had to move far beyond pelvic lesions.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
VANCOUVER – Although symptoms can start young in endometriosis – sometimes in adolescence – women often suffer for years from bowel problems, pain, dyspareunia, and other complications before the condition is recognized and addressed.
Endometriosis can be “a monster of a disease,” especially if it’s not recognized early, said Deborah Bush, cofounder and CEO of the patient advocacy group Endometriosis New Zealand.
To help, she and her colleagues started an education program in New Zealand to teach secondary school students how to recognize – and seek help – when menstrual symptoms fall outside the norm.
In an interview at the World Congress on Endometriosis, Ms. Bush explained the importance of such efforts, and the impact they’ve had in New Zealand over the past 20 years (Aust N Z J Obstet Gynaecol. 2017 Mar 28. doi: 10.1111/ajo.12614).
She also gave an example from her own endometriosis consulting practice of what it took to turn around a patient who had been suffering with the disease for 15 years. Treatment had to move far beyond pelvic lesions.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
VANCOUVER – Although symptoms can start young in endometriosis – sometimes in adolescence – women often suffer for years from bowel problems, pain, dyspareunia, and other complications before the condition is recognized and addressed.
Endometriosis can be “a monster of a disease,” especially if it’s not recognized early, said Deborah Bush, cofounder and CEO of the patient advocacy group Endometriosis New Zealand.
To help, she and her colleagues started an education program in New Zealand to teach secondary school students how to recognize – and seek help – when menstrual symptoms fall outside the norm.
In an interview at the World Congress on Endometriosis, Ms. Bush explained the importance of such efforts, and the impact they’ve had in New Zealand over the past 20 years (Aust N Z J Obstet Gynaecol. 2017 Mar 28. doi: 10.1111/ajo.12614).
She also gave an example from her own endometriosis consulting practice of what it took to turn around a patient who had been suffering with the disease for 15 years. Treatment had to move far beyond pelvic lesions.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT WCE 2017
VIDEO: Endometriosis research: What women want
VANCOUVER – To define the top 10 research priorities in endometriosis, researchers at the University of Edinburgh, Scotland, and their colleagues did something unusual in the world of medical science. They asked the women who have the disease.
More than 70% of the 1,225 people initially surveyed to define what most needs to be figured out in endometriosis were patients, and most of the rest were clinicians who take care of them. Patients were involved throughout an exhaustive process that whittled down nearly 5,000 initial suggestions to a list of 10 priorities.
The first priority is to determine if endometriosis can be cured, and the second task is to find its cause (Lancet. 2017 May 18. doi: 10.1016/S0140-6736(17)31344-2).
Women who have endometriosis said they want a noninvasive diagnostic test. They also want help managing the emotional and physical impacts of living with the disease, not simply treatments that focus on lesions, according to Andrew Horne, MBChB, PhD, a professor of gynecology and reproductive sciences at the University of Edinburgh, who led the efforts.
In an interview at the World Congress on Endometriosis, Dr. Horne explained why it’s critical to define the top research priorities and what doing so could mean for patients and doctors. He also explained the importance of a recent insight into the pathogenesis of endometriosis: It behaves like cancer.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
VANCOUVER – To define the top 10 research priorities in endometriosis, researchers at the University of Edinburgh, Scotland, and their colleagues did something unusual in the world of medical science. They asked the women who have the disease.
More than 70% of the 1,225 people initially surveyed to define what most needs to be figured out in endometriosis were patients, and most of the rest were clinicians who take care of them. Patients were involved throughout an exhaustive process that whittled down nearly 5,000 initial suggestions to a list of 10 priorities.
The first priority is to determine if endometriosis can be cured, and the second task is to find its cause (Lancet. 2017 May 18. doi: 10.1016/S0140-6736(17)31344-2).
Women who have endometriosis said they want a noninvasive diagnostic test. They also want help managing the emotional and physical impacts of living with the disease, not simply treatments that focus on lesions, according to Andrew Horne, MBChB, PhD, a professor of gynecology and reproductive sciences at the University of Edinburgh, who led the efforts.
In an interview at the World Congress on Endometriosis, Dr. Horne explained why it’s critical to define the top research priorities and what doing so could mean for patients and doctors. He also explained the importance of a recent insight into the pathogenesis of endometriosis: It behaves like cancer.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
VANCOUVER – To define the top 10 research priorities in endometriosis, researchers at the University of Edinburgh, Scotland, and their colleagues did something unusual in the world of medical science. They asked the women who have the disease.
More than 70% of the 1,225 people initially surveyed to define what most needs to be figured out in endometriosis were patients, and most of the rest were clinicians who take care of them. Patients were involved throughout an exhaustive process that whittled down nearly 5,000 initial suggestions to a list of 10 priorities.
The first priority is to determine if endometriosis can be cured, and the second task is to find its cause (Lancet. 2017 May 18. doi: 10.1016/S0140-6736(17)31344-2).
Women who have endometriosis said they want a noninvasive diagnostic test. They also want help managing the emotional and physical impacts of living with the disease, not simply treatments that focus on lesions, according to Andrew Horne, MBChB, PhD, a professor of gynecology and reproductive sciences at the University of Edinburgh, who led the efforts.
In an interview at the World Congress on Endometriosis, Dr. Horne explained why it’s critical to define the top research priorities and what doing so could mean for patients and doctors. He also explained the importance of a recent insight into the pathogenesis of endometriosis: It behaves like cancer.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT WCE 2017
Oral GnRH antagonist offers endometriosis pain relief in trials
VANCOUVER – An oral agent reduced dysmenorrhea and nonmenstrual pelvic pain in endometriosis patients, with more fine control over estrogen levels than historically seen with injectable gonadotropin-releasing hormone (GnRH) agonists, according to findings from two randomized controlled trials.
Elagolix is an oral, nonpeptide, gonadotropin-releasing hormone (GnRH) antagonist being developed by Neurocrine Biosciences and AbbVie. Its dose can be adjusted in an attempt to achieve estrogen levels in the optimal “therapeutic window” that controls endometriosis pain while reducing menopausal symptoms, according to Hugh S. Taylor, MD, professor of obstetrics, gynecology and reproductive services at Yale University, New Haven, Conn., and chief of obstetrics and gynecology at Yale–New Haven Hospital, who presented the research at the World Congress on Endometriosis.
Results from two phase III clinical trials, simultaneously published in the New England Journal of Medicine, show that two different doses of elagolix – 150 mg once daily or 200 mg twice daily – improved moderate or severe endometriosis-associated pain. However, patients taking the drug experienced heightened frequencies of hot flushes and increased serum lipid levels, and decreases from baseline in bone mineral density (N Engl J Med. 2017 May 19. doi: 10.1056/NEJMoa1700089).
Still, the two doses give physicians options in tailoring the drug for their patients, Dr. Taylor said. The key is to keep the levels within the therapeutic window. “That’s always been the goal, and now we have a drug that does that. You can customize it for your patient, using the stronger dose for those who need it,” he said.
He described the results from two parallel clinical trials, one conducted in the United States and Canada (Elaris Endometriosis I, n = 872) and one conducted at 187 sites on five continents (Elaris Endometriosis II, n = 817).
Patients were allowed to use NSAIDs (500 mg of naproxen) or an opioid, or both, as needed. Dr. Taylor reported the results after 6 months of treatment.
Both doses of the drug outperformed placebo in reducing dysmenorrhea at 3 months. In Elaris EM-I, 75.8% in the high-dose group and 46.4% in the low-dose group had a clinically significant reduction in dysmenorrhea and decreased or stable use of analgesics at 3 months, compared with 19.6% in the placebo group. In Elaris EM-II, 72.4% in the high-dose group and 43.4% in the low-dose group achieved a clinically significant reduction, compared with 22.7% in the placebo group (P less than .001 for all comparisons).
For nonmenstrual pelvic pain, the two doses of elagolix again bested placebo. In Elaris EM-I, 54.5% in the high-dose group and 50.4% in the low-dose group achieved a clinically significant reduction and a decreased or stable use of analgesics, compared with 36.5% on placebo (P less than .001 for all). In Elaris EM-II, 57.8% in the high-dose group and 49.8% in the low-dose group achieved a clinically significant response, compared with 36.5% in the placebo group (P less than .001 and P = .003, respectively).
The responses were sustained at 6 months for both outcomes.
In Elaris EM-I, hot flushes were reported by 7.0% of the placebo group, 23.7% of the low-dose group, and 42.3% of the high-dose group (P less than .001). In Elaris EM-II, they were reported in 10.3% of the placebo group, 22.6% of the low-dose group, and 47.6% of the high-dose group (P less than .001).
Patients in the elagolix groups experienced increases in total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides, though the researchers noted that less than 20% of participants in each group had LDL levels higher than 160 mg/dL or triglycerides levels higher than 200 mg/dL at any point during treatment.
There were also decreases in bone mineral density in the elagolix groups, but after 6 months of treatment, a z score of –1.5 or less at the lumbar spine occurred in fewer than 5% of women in the elagolix groups.
The drug should provide a more palatable option to GnRH agonists, according to Dr. Taylor. “This is a big step forward, very effective and much more tolerable. I think having an oral, rapidly acting, reversible drug, with a couple of doses available, will make this much more widely accepted and just as effective.”
The study was sponsored by AbbVie. Dr. Taylor and other researchers on the study reported financial ties to AbbVie and other pharmaceutical companies.
VANCOUVER – An oral agent reduced dysmenorrhea and nonmenstrual pelvic pain in endometriosis patients, with more fine control over estrogen levels than historically seen with injectable gonadotropin-releasing hormone (GnRH) agonists, according to findings from two randomized controlled trials.
Elagolix is an oral, nonpeptide, gonadotropin-releasing hormone (GnRH) antagonist being developed by Neurocrine Biosciences and AbbVie. Its dose can be adjusted in an attempt to achieve estrogen levels in the optimal “therapeutic window” that controls endometriosis pain while reducing menopausal symptoms, according to Hugh S. Taylor, MD, professor of obstetrics, gynecology and reproductive services at Yale University, New Haven, Conn., and chief of obstetrics and gynecology at Yale–New Haven Hospital, who presented the research at the World Congress on Endometriosis.
Results from two phase III clinical trials, simultaneously published in the New England Journal of Medicine, show that two different doses of elagolix – 150 mg once daily or 200 mg twice daily – improved moderate or severe endometriosis-associated pain. However, patients taking the drug experienced heightened frequencies of hot flushes and increased serum lipid levels, and decreases from baseline in bone mineral density (N Engl J Med. 2017 May 19. doi: 10.1056/NEJMoa1700089).
Still, the two doses give physicians options in tailoring the drug for their patients, Dr. Taylor said. The key is to keep the levels within the therapeutic window. “That’s always been the goal, and now we have a drug that does that. You can customize it for your patient, using the stronger dose for those who need it,” he said.
He described the results from two parallel clinical trials, one conducted in the United States and Canada (Elaris Endometriosis I, n = 872) and one conducted at 187 sites on five continents (Elaris Endometriosis II, n = 817).
Patients were allowed to use NSAIDs (500 mg of naproxen) or an opioid, or both, as needed. Dr. Taylor reported the results after 6 months of treatment.
Both doses of the drug outperformed placebo in reducing dysmenorrhea at 3 months. In Elaris EM-I, 75.8% in the high-dose group and 46.4% in the low-dose group had a clinically significant reduction in dysmenorrhea and decreased or stable use of analgesics at 3 months, compared with 19.6% in the placebo group. In Elaris EM-II, 72.4% in the high-dose group and 43.4% in the low-dose group achieved a clinically significant reduction, compared with 22.7% in the placebo group (P less than .001 for all comparisons).
For nonmenstrual pelvic pain, the two doses of elagolix again bested placebo. In Elaris EM-I, 54.5% in the high-dose group and 50.4% in the low-dose group achieved a clinically significant reduction and a decreased or stable use of analgesics, compared with 36.5% on placebo (P less than .001 for all). In Elaris EM-II, 57.8% in the high-dose group and 49.8% in the low-dose group achieved a clinically significant response, compared with 36.5% in the placebo group (P less than .001 and P = .003, respectively).
The responses were sustained at 6 months for both outcomes.
In Elaris EM-I, hot flushes were reported by 7.0% of the placebo group, 23.7% of the low-dose group, and 42.3% of the high-dose group (P less than .001). In Elaris EM-II, they were reported in 10.3% of the placebo group, 22.6% of the low-dose group, and 47.6% of the high-dose group (P less than .001).
Patients in the elagolix groups experienced increases in total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides, though the researchers noted that less than 20% of participants in each group had LDL levels higher than 160 mg/dL or triglycerides levels higher than 200 mg/dL at any point during treatment.
There were also decreases in bone mineral density in the elagolix groups, but after 6 months of treatment, a z score of –1.5 or less at the lumbar spine occurred in fewer than 5% of women in the elagolix groups.
The drug should provide a more palatable option to GnRH agonists, according to Dr. Taylor. “This is a big step forward, very effective and much more tolerable. I think having an oral, rapidly acting, reversible drug, with a couple of doses available, will make this much more widely accepted and just as effective.”
The study was sponsored by AbbVie. Dr. Taylor and other researchers on the study reported financial ties to AbbVie and other pharmaceutical companies.
VANCOUVER – An oral agent reduced dysmenorrhea and nonmenstrual pelvic pain in endometriosis patients, with more fine control over estrogen levels than historically seen with injectable gonadotropin-releasing hormone (GnRH) agonists, according to findings from two randomized controlled trials.
Elagolix is an oral, nonpeptide, gonadotropin-releasing hormone (GnRH) antagonist being developed by Neurocrine Biosciences and AbbVie. Its dose can be adjusted in an attempt to achieve estrogen levels in the optimal “therapeutic window” that controls endometriosis pain while reducing menopausal symptoms, according to Hugh S. Taylor, MD, professor of obstetrics, gynecology and reproductive services at Yale University, New Haven, Conn., and chief of obstetrics and gynecology at Yale–New Haven Hospital, who presented the research at the World Congress on Endometriosis.
Results from two phase III clinical trials, simultaneously published in the New England Journal of Medicine, show that two different doses of elagolix – 150 mg once daily or 200 mg twice daily – improved moderate or severe endometriosis-associated pain. However, patients taking the drug experienced heightened frequencies of hot flushes and increased serum lipid levels, and decreases from baseline in bone mineral density (N Engl J Med. 2017 May 19. doi: 10.1056/NEJMoa1700089).
Still, the two doses give physicians options in tailoring the drug for their patients, Dr. Taylor said. The key is to keep the levels within the therapeutic window. “That’s always been the goal, and now we have a drug that does that. You can customize it for your patient, using the stronger dose for those who need it,” he said.
He described the results from two parallel clinical trials, one conducted in the United States and Canada (Elaris Endometriosis I, n = 872) and one conducted at 187 sites on five continents (Elaris Endometriosis II, n = 817).
Patients were allowed to use NSAIDs (500 mg of naproxen) or an opioid, or both, as needed. Dr. Taylor reported the results after 6 months of treatment.
Both doses of the drug outperformed placebo in reducing dysmenorrhea at 3 months. In Elaris EM-I, 75.8% in the high-dose group and 46.4% in the low-dose group had a clinically significant reduction in dysmenorrhea and decreased or stable use of analgesics at 3 months, compared with 19.6% in the placebo group. In Elaris EM-II, 72.4% in the high-dose group and 43.4% in the low-dose group achieved a clinically significant reduction, compared with 22.7% in the placebo group (P less than .001 for all comparisons).
For nonmenstrual pelvic pain, the two doses of elagolix again bested placebo. In Elaris EM-I, 54.5% in the high-dose group and 50.4% in the low-dose group achieved a clinically significant reduction and a decreased or stable use of analgesics, compared with 36.5% on placebo (P less than .001 for all). In Elaris EM-II, 57.8% in the high-dose group and 49.8% in the low-dose group achieved a clinically significant response, compared with 36.5% in the placebo group (P less than .001 and P = .003, respectively).
The responses were sustained at 6 months for both outcomes.
In Elaris EM-I, hot flushes were reported by 7.0% of the placebo group, 23.7% of the low-dose group, and 42.3% of the high-dose group (P less than .001). In Elaris EM-II, they were reported in 10.3% of the placebo group, 22.6% of the low-dose group, and 47.6% of the high-dose group (P less than .001).
Patients in the elagolix groups experienced increases in total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides, though the researchers noted that less than 20% of participants in each group had LDL levels higher than 160 mg/dL or triglycerides levels higher than 200 mg/dL at any point during treatment.
There were also decreases in bone mineral density in the elagolix groups, but after 6 months of treatment, a z score of –1.5 or less at the lumbar spine occurred in fewer than 5% of women in the elagolix groups.
The drug should provide a more palatable option to GnRH agonists, according to Dr. Taylor. “This is a big step forward, very effective and much more tolerable. I think having an oral, rapidly acting, reversible drug, with a couple of doses available, will make this much more widely accepted and just as effective.”
The study was sponsored by AbbVie. Dr. Taylor and other researchers on the study reported financial ties to AbbVie and other pharmaceutical companies.
Key clinical point:
Major finding: At 3 and 6 months, the drug achieved a clinically significant reduction in dysmenorrhea for between 43% and 77% of women, compared with placebo (P less than .001).
Data source: Two phase III controlled trials randomizing nearly 1,700 with surgically confirmed endometriosis.
Disclosures: The study was sponsored by AbbVie. Dr. Taylor and other researchers on the study reported financial ties to AbbVie and other pharmaceutical companies.