Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Adamian, BS, Creighton University School of Medicine-Phoenixix Regional Campus, Phoenix, AZ. Miro, BS, Callan, BS, M. Patel, BS, Patel, BS, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE.
Psychopharmacol Bull. 2020 Oct 15;50(4 Suppl 1):197-215.
This is a review of elagolix use for pain related to endometriosis. It summarizes the background and recent data available about the pathogenesis of endometriosis and pain that is secondary to this syndrome. It then reviews the evidence to support the use of elagolix and the indications for use.
Endometriosis occurs in 10% of reproductive-age women and is a common source of chronic pelvic pain, infertility, and co-morbid disorders. It usually presents with some combination of dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. Treatment options may be surgical or hormonal. Traditional treatment is divided into medical and surgical. The latter, though effective, is reserved for surgical emergencies and patients failing medical management. Medical management with NSAIDs is usually limited in efficacy. It is generally based on hormonal suppression leading to atrophy of endometrial lesions. Elagolix (Orlissa) is a GnRH antagonist that suppressed the entire hypophysis-gonadal axis. Reduced levels of estrogen and progesterone lead to involution of the endometrial lesions and improvement in symptoms. Clinical trials showed that elagolix is effective in treating dysmenorrhea and non-menstrual pain that is secondary to endometriosis. It is well tolerated and has a relatively safe usage profile. Studies up to 12 months long showed continued efficacy and reduction in dysmenorrhea of up to 75%, with 50%-60% reduction in non-menstrual pain. Elagolix was found effective when compared to both placebo and alternative treatments.
Endometriosis is a common syndrome that causes significant pain, morbidity, and disability, as well as financial loss. Elagolix is an effective drug in treating the symptoms of endometriosis and is a relatively safe option. Phase 4 studies will be required to evaluate the safety and efficacy of long term chronic use.
本文综述了 Elagolix 治疗与子宫内膜异位症相关疼痛的用途。本文总结了子宫内膜异位症发病机制和继发于该综合征的疼痛的背景和最新数据，并回顾了支持 Elagolix 应用的证据及其适应证。
子宫内膜异位症在育龄期妇女中的发病率为 10%，是慢性盆腔疼痛、不孕和并存疾病的常见病因。其通常表现为痛经、性交痛、慢性盆腔痛和不孕的某种组合。治疗方案可能是手术或激素治疗。传统治疗方法分为手术和药物治疗。后者虽然有效，但保留用于手术紧急情况和药物治疗失败的患者。非甾体抗炎药（NSAIDs）的药物治疗通常疗效有限。其通常基于激素抑制，导致子宫内膜病变萎缩。Elagolix（Orlissa）是一种 GnRH 拮抗剂，可抑制整个垂体-性腺轴。雌激素和孕激素水平降低导致子宫内膜病变退化，症状改善。临床试验表明，Elagolix 可有效治疗子宫内膜异位症引起的痛经和非经期疼痛。它具有良好的耐受性和相对安全的使用情况。长达 12 个月的研究显示其持续有效，并使痛经减轻高达 75%，非经期疼痛减轻 50%-60%。与安慰剂和替代治疗相比，Elagolix 被证明是有效的。
子宫内膜异位症是一种常见的综合征，可引起严重疼痛、发病和残疾，以及经济损失。Elagolix 是一种治疗子宫内膜异位症症状的有效药物，是一种相对安全的选择。需要进行 4 期研究来评估长期慢性使用的安全性和疗效。
