This article is more than 5 years old. Information may no longer be current.

Endometriosis emerging as complex, systemic disease often requiring medical treatment

Hugh Taylor

NASHVILLE, Tenn. — Endometriosis, long thought to be solely a painful condition resulting in painful lesions in the peritoneal cavity, should really be thought of, and managed, much differently, according to a presenter at the American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting.

“What you see in the pelvis is just part of the disease,” Hugh Taylor, MD, Anita O'Keeffe Young Professor of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine, told attendees. “It is a systemic disease.”

Molecular data and animal modeling have shown that inappropriate development of stem cells and micrometastasis can affect liver metabolism, the spleen and lungs, and manifest in the brain, increasing a patient’s depression, anxiety and pain sensitization, Taylor said. In addition, while thinner patients were thought to be at greater risk for endometriosis, new research is showing that the disease actually causes weight loss. There is also some evidence of cardiovascular disease as a long-term sequelae of endometriosis.

“The systemic effects of endometriosis are more significant than the manifestations in the pelvis,” he said.

The previous approach to treatment has been surgical removal of lesions, but medical therapy is taking on a more significant role, Taylor said.

Contraceptives containing progestin, either oral or IUDs, had been the mainstay of treatment, but many patients would develop resistance over time, resulting in pain breakthroughs, Taylor said. Emerging data suggest that some patients have lower levels of receptor expression, which may help clinicians to identify patients more likely to develop progestin resistance.

The gonadotropin-releasing hormone (GnRH) antagonist Orlissa (elagolix, AbbVie and Neurocrine Biosciences), approved in July 2018, has been shown to rapidly reduce pain, depression and anxiety, while avoiding adverse effects associated with other medical endometriosis, such as androgen, which resulted in hair growth and acne in some patients, Taylor said. Available in 150-mg and 200-mg doses, elagolix allows clinicians to tailor treatment to the severity of the patient’s condition, while being easily reversible, he said.

 

Endometriosis, long thought to be solely a painful condition resulting in painful lesions in the peritoneal cavity, should really be thought of, and managed, much differently, according to a presenter at the American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting.

Source:Adobe

In Elaris EM I and Elaris EM II trials, the most significant adverse event was hot flashes, which resulted in discontinuation in less than 1% of patients receiving the 150-mg dose and less than 3% of patients receiving the 200-mg dose.

Some patients did experience a loss of bone density, resulting in the FDA approvals for elagolix limiting duration of treatment to 2 years at 150 mg and 6 months at 200 mg.

Patients taking elagolix who are looking for contraceptive options should be counseled to avoid estrogen-containing agents in favor of oral or IUD progestin, Taylor said. – by Chris Rosenberg

Reference: Taylor H. “Pathophysiology and treatment of endometriosis.” Presented at: American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting; May 3-6, 2019; Nashville, Tenn.

Disclosures: Healio Primary Care Today was unable to determine Taylor’s relevant financial disclosures prior to publication.