Efficacy of GnRH antagonists in the treatment of uterine fibroids: a meta-analysis.

IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Archives of Gynecology and Obstetrics Pub Date : 2025-01-16 DOI:10.1007/s00404-025-07932-9
María Jésus Sánchez Martín, Cristina Huerga López, Ignacio Cristóbal García, Ignacio Cristóbal Quevedo
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Abstract

Purpose: Uterine fibroids are the most common pelvic tumors in women, representing the primary indication of hysterectomy. Gonadotropin-releasing hormone (GnRH) antagonists represent a new therapeutic option for premenopausal women. The aim of this review is to evaluate the efficacy and safety of GnRH antagonists in the treatment of uterine fibroids (size reduction and symptom control).

Methods: A review of studies from electronic databases (PubMed and Cochrane Central) published up to December 2023 was performed. Eleven randomized clinical trials with a total of 4164 patients were included in the review, which evaluated GnRH antagonists (Relugolix, Elagolix, Linzagolix and Cetrorelix) against placebo or GnRH agonists in premenopausal women with uterine fibroids and heavy menstrual bleeding.

Results: The results of the measures evaluated to determine the efficacy and safety of GnRH antagonists versus placebo are favorable for the variables of control of uterine bleeding (Relative risk (RR) = 5.09; 95% CI 3.19 to 8.14), percentage reduction of fibroid volume (Mean difference (MD) = -27.36; 95% CI -38.89 to -15.83) and lower reduction of bone density (MD -0.35; 95% CI -0.47 to -0.24). The results do not allow us to conclude whether there are differences between the alternatives compared in the control of vasomotor symptoms.

Conclusions: GnRH antagonists represent an effective alternative for uterine fibroids treatment as they allow a superior reduction in menstrual bleeding and uterine fibroid volume compared to the placebo group.

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GnRH拮抗剂治疗子宫肌瘤的疗效:荟萃分析。
目的:子宫肌瘤是女性最常见的盆腔肿瘤,是子宫切除术的主要指征。促性腺激素释放激素(GnRH)拮抗剂是绝经前妇女的一种新的治疗选择。本综述的目的是评价GnRH拮抗剂治疗子宫肌瘤(缩小尺寸和症状控制)的有效性和安全性。方法:对截至2023年12月发表的电子数据库(PubMed和Cochrane Central)中的研究进行综述。该综述纳入了11项随机临床试验,共4164例患者,评估了GnRH拮抗剂(Relugolix, Elagolix, Linzagolix和Cetrorelix)与安慰剂或GnRH激动剂在绝经前子宫肌瘤和大量月经出血妇女中的疗效。结果:评价GnRH拮抗剂与安慰剂的疗效和安全性的措施结果在控制子宫出血的变量上是有利的(相对风险(RR) = 5.09;95% CI 3.19 ~ 8.14),肌瘤体积缩小百分比(平均差(MD) = -27.36;95% CI为-38.89 ~ -15.83),骨密度降低幅度较小(MD为-0.35;95% CI -0.47 ~ -0.24)。结果不允许我们得出结论,在控制血管舒缩症状方面是否有不同的选择。结论:GnRH拮抗剂是子宫肌瘤治疗的有效选择,因为与安慰剂组相比,它们可以显著减少月经出血和子宫肌瘤体积。
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来源期刊
CiteScore
4.70
自引率
15.40%
发文量
493
审稿时长
1 months
期刊介绍: Founded in 1870 as "Archiv für Gynaekologie", Archives of Gynecology and Obstetrics has a long and outstanding tradition. Since 1922 the journal has been the Organ of the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. "The Archives of Gynecology and Obstetrics" is circulated in over 40 countries world wide and is indexed in "PubMed/Medline" and "Science Citation Index Expanded/Journal Citation Report". The journal publishes invited and submitted reviews; peer-reviewed original articles about clinical topics and basic research as well as news and views and guidelines and position statements from all sub-specialties in gynecology and obstetrics.
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