Pituitary desensitization for eight weeks after the administration of two distinct gonadotrophin-releasing hormone agonists

Matteo, Maria; Caroppo, Ettore; Gliozheni, Orion; Carone, Domenico; Schönauer, Luca Maria; Vizziello, G; Greco, Pantaleo; D’Amato, Giuseppe

doi:10.1016/j.ejogrb.2005.09.018

Cited by 5 publications

(6 citation statements)

References 13 publications

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“…A study demonstrates that, after a single dose of administration, leuprolin and triptorelin depots (3.75 mg) induce satisfactory ovarian suppression up to 6 and 7 weeks, respectively, with significantly reduced levels of endogenous LH [7] . Another study by Matteo et al [8] reports a similar result. Triptorelin has a longer duration Color version available online of action, allowing its administration at a longer interval in these patients.…”

Section: Discussionsupporting

confidence: 73%

Efficacy of Gonadotropin-Releasing Hormone Agonist and an Extended-Interval Dosing Regimen in the Treatment of Patients with Adenomyosis and Endometriosis

Kang

Wang

Nie

et al. 2009

Gynecol Obstet Invest

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Aims: To determine the effects of gonadotropin-releasing hormone agonist (GnRH-a) and an extended-interval dosing regimen in the treatment of patients with adenomyosis and endometriosis. Methods: This was a prospective observational study in the setting of a hospital outpatient clinic. Seventy women suffering from adenomyosis and endometriosis were randomly divided into 2 groups: extended-interval dosing (experimental group) and conventional dosing (control group). Methods: Patients in the experimental group received a 4-dose regimen (triptorelin 3.75 mg by intramuscular injection every 6 weeks for a total of 4 doses). The patients in the control group received a conventional regimen (1 injection every 4 weeks for a total of 6 doses). The main outcome measures were relief and recurrence of dysmenorrhea and related climacteric symptoms, reduction of uterine volume, and serum levels of 17-β-oestradiol (E₂), luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Results: The reliving rate of dysmenorrhea was 100% in patients treated with both the new regimen and the convention regimen after 6 months. The uterine volume was reduced 37.6% and 39.2%, respectively. And the levels of LH, FSH and E₂ were decreased significantly (p < 0.001). The E₂levels were reduced to the postmenopausal level. The hormone profile of the experimental group was similar to that of the control group (p > 0.05). Conclusion: The use of the extended-interval dosing regimen of triptorelin depot in patients with adenomyosis or endometriosis results in a consistent hypo-oestrogenised state, which is similar to that achieved by the conventional regimen. The new regimen reduces the cost of treatment.

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Section: Discussionsupporting

confidence: 73%

Efficacy of Gonadotropin-Releasing Hormone Agonist and an Extended-Interval Dosing Regimen in the Treatment of Patients with Adenomyosis and Endometriosis

Kang

Wang

Nie

et al. 2009

Gynecol Obstet Invest

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“…Regarding gonadotropin secretion, adult studies comparing LA and TR depot preparations observed a difference in their potency and duration of action [17,18]. Two studies of adult females during the first 3 treatment months reported E 2 levels that were slightly but not significantly higher in the TR group compared to the LA group [17,30], and similar LH levels occurred in response to GnRH-stimulating tests.…”

Section: Discussionmentioning

confidence: 91%

“…These analyses were restricted to the first 4–12 weeks after administration of the analog [12,17,18]. Few studies have been performed in children with longer GnRHa treatment (2.5–3.5 years) and investigate different GnRHa-induced clinical aspects [19,20,21].…”

Section: Introductionmentioning

confidence: 99%

Growth Outcome during GnRH Agonist Treatments for Slowly Progressive Central Precocious Puberty

et al. 2009

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Background: Gonadotropin-releasing hormone agonists (GnRHa) represent the gold-standard treatment for central precocious puberty (CPP). In CPP children, GnRHa treatment slows bone age progression and preserves adult height (Ht) by suppressing sexual steroid secretion. In some patients, however, GnRHa induce an inappropriate growth deceleration impairing Ht outcome. Furthermore, slowly progressive CPP (spCPP) forms were reported which do not need GnRHa treatment. Methods: We evaluated the growth outcome of 26 spCPP girls treated with triptorelin (TR) and 21 with leuprorelin acetate (LA) for 36.5 ± 0.7 months. Results: GnRHa treatment induced a progressive growth deceleration in both spCPP groups. No difference in bone maturation was detected (p > 0.05; TR vs. LA group), however compared to LA, TR treatment resulted in significantly higher Ht after 24 months (p < 0.05; LA vs. TR group). Although target height (TH) standard deviation score (SDS) and predicted adult height (PAH)-SDS at diagnosis were similar in both spCPP groups (p > 0.05; LA vs. TR group), final height (FH-SDS) was lower in LA-treated subjects (p < 0.05; LA vs. TR group). In both spCPP groups, FH-SDS was significantly lower than TH-SDS (p < 0.001) but not lower than PAH-SDS at diagnosis (p > 0.05). Ht-SDS correlated with 17β-estradiol (E₂) blood levels in both spCPP groups (p < 0.0001) throughout GnRHa treatment, and E₂ values were higher in the TR- than in the LA-treated patients during the 12 months after GnRHa administration (p < 0.05; LA vs. TR group). GnRHa-induced E₂ secretion and Ht-SDS at GnRHa withdrawal correlated positively with FH (p < 0.01 and p < 0.001, respectively). Conclusions: The effectiveness of GnRHa treatment in improving FH in spCPP girls was doubtful.

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“…One of these studies focused on intermittent GnRH agonist treatment ( Tanaka and Umesaki, 2001 ), one focused on low-dose, draw-back GnRH agonist therapy ( Liu et al , 2013 ), and one focused on an extended-interval GnRH agonist dosing regimen ( Liu et al , 2006 ). A total of eight articles addressing the biological rationale underpinning each individual alternative GnRH agonist use were identified but were excluded from the systematic review as clinical outcomes were not measured ( Barbieri, 1992 ; Broekmans et al , 1992 ; Henzl, 1992 ; Filicori et al , 1998 ; Cheung et al , 2000 ; Matteo et al , 2006 ; Li et al , 2014 ; Pohl et al , 2022 ). The article selection process is described in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…With the objective of evaluating the duration of pituitary desensitization after a single i.m. injection of 3.75 mg of triptorelin or leuprorelin, Matteo et al (2006) recruited 60 women with stages I–II endometriosis and administered a depot preparation of each GnRH agonist on the 21st day of the cycle to 30 participants. Based on serial weekly determinations of serum FSH, LH, and E2 levels, the two drugs similarly suppressed the pituitary–ovarian axis until the fourth week post-injection.…”

Section: Resultsmentioning

confidence: 99%

Mitigating the economic burden of GnRH agonist therapy for progestogen-resistant endometriosis: why not?

Vercellini

Bandini

Buggio

et al. 2023

Human Reproduction Open

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STUDY QUESTION Is it possible to reduce the cost of GnRH agonist treatment for endometriosis by using non-standard dosing regimens? SUMMARY ANSWER An extended-interval dosing regimen of a 3.75 mg depot formulation of triptorelin injected every 6 weeks instead of every 4 weeks reduces the cost by one-third without compromising the effect on pain relief. WHAT IS KNOWN ALREADY Cost constitutes a limit to prolonged GnRH agonists use. Alternative modalities to reduce the economic burden of GnRH agonist treatment have been anecdotally attempted. STUDY DESIGN, SIZE, DURATION A systematic review was conducted to evaluate and compare the effect of three alternative modalities for GnRH use in women with endometriosis, i.e. intermittent oestrogen deprivation therapy, reduced drug dosage, and extended-interval dosing regimens of depot formulations. A PubMed and Embase search was initially conducted in October 2022 and updated in January 2023 using the following search strings: (endometriosis OR adenomyosis) AND (GnRH-agonists OR gonadotropin-releasing hormone agonists OR triptorelin OR leuprorelin OR goserelin OR buserelin OR nafarelin). Full-length articles published in English in peer-reviewed journals since 1 January 1980, and reporting original data on GnRH agonist treatment of pain symptoms associated with endometriosis were selected. PARTICIPANTS/MATERIALS, SETTING, METHODS Information was extracted on study design, GnRH-agonist used, dosage, total duration of therapy, side effects, treatment adherence, and pelvic pain relief. Reviews, commentaries, conference proceedings, case reports, and letters to the editor were excluded. MAIN RESULTS AND THE ROLE OF CHANCE Of the 1664 records screened, 14 studies regarding clinical outcomes associated with the 3 considered alternative modalities for GnRH agonist use were eventually included (intermittent oestrogen deprivation therapy, n = 2; low-dose or ‘draw-back’ therapy, n = 8; extended-interval dosing regimen, n = 4). Six studies were randomized controlled trials (RCTs) (double blind, n = 2) and eight adopted a prospective cohort design (non-comparative, n = 6; comparative, n = 2). A total of 776 women with endometriosis were recruited in the above studies (intermittent oestrogen deprivation therapy, n = 77; low-dose or ‘draw-back’ therapy, n = 528; extended-interval dosing regimen, n = 171). Robust data demonstrating cost saving without detrimental clinical consequences were available for the extended-interval dosing regimen only. In particular, the 3.75 mg triptorelin depot preparation inhibits ovarian function for a longer period compared with the 3.75 mg leuprorelin depot preparation, allowing injections every 6 instead of 4 weeks. Based on the cost indicated by the Italian Medicine Agency for the 3.75 mg triptorelin depot preparation, this would translate in a yearly saving of €744.60 (€2230.15–€1485.55; −33.4%). LIMITATIONS, REASONS FOR CAUTION The quality of the evidence reported in the selected articles was not formally evaluated and a quantitative synthesis could not be performed. Some studies were old and the tested therapeutic approaches were apparently obsolete. Only cost containment associated with GnRH analogue use, and not cost-effectiveness, has been addressed. WIDER IMPLICATIONS OF THE FINDINGS Consuming less resources without negatively impacting on health outcomes carries ethical and practical implications for individuals and the community, as this approach may result in overall increased healthcare access. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the Italian Ministry of Health (Ricerca Corrente 2023, IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano). E.S. discloses payments from Ferring for research grants and honoraria from Merck-Serono for lectures. All other authors declare they have no conflict of interest. REGISTRATION NUMBER N/A.

show abstract

Pituitary desensitization for eight weeks after the administration of two distinct gonadotrophin-releasing hormone agonists

Cited by 5 publications

References 13 publications

Efficacy of Gonadotropin-Releasing Hormone Agonist and an Extended-Interval Dosing Regimen in the Treatment of Patients with Adenomyosis and Endometriosis

Efficacy of Gonadotropin-Releasing Hormone Agonist and an Extended-Interval Dosing Regimen in the Treatment of Patients with Adenomyosis and Endometriosis

Growth Outcome during GnRH Agonist Treatments for Slowly Progressive Central Precocious Puberty

Mitigating the economic burden of GnRH agonist therapy for progestogen-resistant endometriosis: why not?

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