<p>Clinical Utility Of Elagolix As An Oral Treatment For Women With Uterine Fibroids: A Short Report On The Emerging Efficacy Data</p>

Abstract

Uterine fibroids (UFs) are the most common gynaecological benign disease. Even though often asymptomatic, UFs can worsen women’s health and their quality of life, causing heavy bleeding and anaemia, pelvic discomfort and reduced fertility. Surgical treatment of UFs could be limited by its invasiveness and the desire to preserve fertility. Thus, effective medical therapies for the management of this condition are needed. Common drugs used to control bleeding, such us hormonal contraceptive or levonorgestrel-releasing intrauterine system, have no effect on fibroids volume. Among other more efficient treatments, the gonadotropin-releasing hormone (GnRH) agonist or the selective progesterone-receptor modulators have a non-neutral safety profile; thus, they are used for limited periods or for cyclic treatments. Elagolix is a potent, orally bioavailable, non-peptide GnRH antagonist that acts by a competitive block of the GnRH receptor. The biological effect is a dose-dependent inhibition of gonadal axis, without a total suppression of estradiol concentrations. For this reason, even though comparative studies between elagolix and GnRH agonists have not been performed, elagolix has been associated with a better profile of adverse events. Recently, elagolix received US FDA approval for the treatment of moderate to severe pain caused by endometriosis. Several clinical trials assessed the efficacy of elagolix for the treatment of heavy bleeding caused by UFs and the definitive results of Phase III studies are expected. Available data on elagolix and UFs showed that the drug, with or without low-dose hormone add-back therapy, is able to significantly reduce menstrual blood loss, lead to amenorrhea and improve haemoglobin concentrations in the majority of participants in comparison with placebo. The safety and tolerability profile appeared generally acceptable. The concomitant use of add-back therapy can prevent bone loss due to the hypoestrogenic effect and can improve safety during elagolix treatment.

Elagolix Treatment in Women With Heavy Menstrual Bleeding Associated With Uterine Fibroid: A Systematic Review and Meta-analysis

“…Two reviews, one on predictors of response to elagolix with add-back therapy and the other on medical treatment of uterine leiomyoma, were relevant to our research query (4,23). There was no outcome of interest in the four papers as two papers (3,11) on elagolix pharmacotherapy and pharmacodynamics and another two more papers (14,24) on drug-drug interactions were written. Adenomyosis was the topic of two more publications (25,26).…”

Assessment of Clinical Drug‐Drug Interactions of Elagolix, a Gonadotropin‐Releasing Hormone Receptor Antagonist

“…In the past 20 years, there have not been any major advancements in medical therapy for these gynecological conditions 1 . Elagolix was approved by the United States Food and Drug Administration (FDA) for the management of moderate to severe pain associated with endometriosis (Orilissa) and in combination with estradiol/norethindrone acetate indicated for the management of heavy menstrual bleeding associated with uterine leiomyomas (fibroids) (Oriahnn) in premenopausal women 3,4,5 . Elagolix, an oral, nonpeptide gonadotropin releasing hormone (GnRH) receptor antagonist, offers patients a novel oral medical treatment option.…”

“…Elagolix, an oral, nonpeptide gonadotropin releasing hormone (GnRH) receptor antagonist, offers patients a novel oral medical treatment option. Elagolix coadministered with estradiol/norethindrone acetate has demonstrated robust efficacy for the treatment of heavy menstrual bleeding associated with uterine fibroids (UFs) in pivotal phase 3 clinical trials (ELARIS UF‐1 and ELARIS UF‐2) 2,4,5 . Common adverse reactions associated with elagolix have been hot flush, headache, and nausea 3,6 .…”

“…1 Elagolix was approved by the United States Food and Drug Administration (FDA) for the management of moderate to severe pain associated with endometriosis (Orilissa) and in combination with estradiol/norethindrone acetate indicated for the management of heavy menstrual bleeding associated with uterine leiomyomas (fibroids) (Oriahnn) in premenopausal women. 3,4,5 Elagolix, an oral, nonpeptide gonadotropin releasing hormone (GnRH) receptor antagonist, offers patients a novel oral medical treatment option. Elagolix coadministered with estradiol/norethindrone acetate has demonstrated robust efficacy for the treatment of heavy menstrual bleeding associated with uterine fibroids (UFs) in pivotal phase 3 clinical trials (ELARIS UF-1 and ELARIS UF-2).…”

“…Elagolix coadministered with estradiol/norethindrone acetate has demonstrated robust efficacy for the treatment of heavy menstrual bleeding associated with uterine fibroids (UFs) in pivotal phase 3 clinical trials (ELARIS UF-1 and ELARIS UF-2). 2,4,5 Common adverse reactions associated with elagolix have been hot flush, headache, and nausea. 3,6 Hypoestrogenic adverse effects such as 300 mg twice daily 20 (19) CYP, cytochrome P450; P-gp, P-glycoprotein; OATP, organic anion-transporting polypeptide.…”