Abstract | BACKGROUND: Among patients using GnRH analogues for endometriosis it has been postulated that peripheral and inflammation-induced in-situ aromatization of adrenal androgens are probably the main reasons for the high rates of failure during follow-up. We hypothesized that in cases with premenopausal severe endometriosis, use of a combination of anastrozole and goserelin to achieve almost maximal endocrine blockade of estrogen synthesis after conservative surgery may increase the pain-free interval and reduce the recurrence rates as compared to goserelin alone. METHODS: In a prospective randomized trial, we evaluated the efficacy of using either a combination of anastrozole and goserelin for 6 months or goserelin alone for 6 months after conservative surgery for severe endometriosis. The primary outcome measures were the symptom recurrence rates and the impact of treatment on endometriosis-related multidimensional score. The secondary outcome measures were the impact of allocated treatment regimens on menopausal quality of life and on lumbar spine bone mineral density (BMD). RESULTS: When we analyzed the Kaplan-Meier survival curves, we detected a statistically significant advantage of goserelin plus anastrozole as compared to goserelin only, in terms of the median time to detect symptom recurrence (>2.4 versus 1.7 months; log-rank test; P=0.0089). This statistically significant advantage occurred with a relative risk of 4.3 [95% confidence interval (CI) 1.3-9.8]. Three cases out of 40 recurred in the goserelin plus anastrozole arm (7.5%), whereas we detected recurrences in 14 cases out of 40 cases in the goserelin-only arm (35%) during the follow-up period of 24 months. Based on these data, the interpretation of Kaplan-Meier curves indicates that at the end of follow-up, 54.7 versus 10.4%, respectively, of the patients were free of recurrence. The mean of the differences in terms of Deltabaseline-24 months post-medical therapy multidimensional score were statistically significant in favour of goserelin and anastrozole (9.2 +/- 2.1 versus 6.7 +/- 2.8; paired t-test; P<0.0001; 95% CI 1.5-4.0). We observed a statistically significant difference in suppression of estradiol concentrations and a significantly greater BMD loss at the end of treatment in the goserelin and anastrozole arm as compared to goserelin-only arm. However, this did not elicit deterioration in menopausal quality of life and the observed bone loss was not significant in terms of DeltaBMD between the groups at 2 years of treatment withdrawal. CONCLUSIONS: Six months of treatment with anastrozole and goserelin as compared to goserelin alone increased the pain-free interval and decreased symptom recurrence rates in patients following surgery for severe endometriosis. Furthermore, menopausal quality of life and BMD at 2 years after medical therapy remained unaffected.
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Authors | Seyide Soysal, Mehmet Emin Soysal, Suzan Ozer, Nýhat Gul, Tugba Gezgin |
Journal | Human reproduction (Oxford, England)
(Hum Reprod)
Vol. 19
Issue 1
Pg. 160-7
(Jan 2004)
ISSN: 0268-1161 [Print] England |
PMID | 14688176
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
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Chemical References |
- Aromatase Inhibitors
- Enzyme Inhibitors
- Nitriles
- Triazoles
- Goserelin
- Anastrozole
- Estradiol
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Topics |
- Adult
- Anastrozole
- Aromatase Inhibitors
- Bone Density
- Drug Administration Schedule
- Drug Therapy, Combination
- Endometriosis
(drug therapy, physiopathology, prevention & control, surgery)
- Enzyme Inhibitors
(administration & dosage, adverse effects)
- Estradiol
(blood)
- Female
- Goserelin
(administration & dosage, adverse effects)
- Humans
- Menopause
- Nitriles
(administration & dosage, adverse effects)
- Palliative Care
- Patient Selection
- Postoperative Care
- Quality of Life
- Secondary Prevention
- Severity of Illness Index
- Survival Analysis
- Treatment Outcome
- Triazoles
(administration & dosage, adverse effects)
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