Treatment of Uterine Myoma with 2.5 or 5 mg Mifepristone Daily during 3 Months with 9 Months Posttreatment Followup: Randomized Clinical Trial

Josep Lluis Carbonell, Rita Acosta, Yasmirian Pérez, Roberto Garcés, Carlos Sánchez, Giuseppe Tomasi, Josep Lluis Carbonell, Rita Acosta, Yasmirian Pérez, Roberto Garcés, Carlos Sánchez, Giuseppe Tomasi

Abstract

Objectives. To evaluate the efficacy, safety, and quality of life by using 2.5 and mifepristone 5 mg daily doses to treat uterine fibroids over 3 months with a 9-month followup period. Design. Randomized clinical trial. Place. "Eusebio Hernández" Hospital, Havana, Cuba. Subjects. 220 women with symptomatic uterine fibroids. Treatment. One-half (2.5 mg) or one-whole 5 mg mifepristone tablet. Variables to Evaluate Efficacy. Changes in fibroid and uterine volumes, in symptomatic prevalence and intensity, and in quality of life. Results. After 3-month treatment, fibroid volume decreased by 27.9% (CI 95% 20-35) and 45.5% (CI 95% 37-62), in the 2.5 and 5 mg groups, respectively, P = 0.003. There was no difference in the prevalence of symptoms at the end of treatment, unlike after 6- and 9-month followup when there was a difference. Amenorrhea was significantly higher in the 5 mg group, P = 0.001. There were no significant differences in mifepristone side effects between the groups. Both groups displayed a similar improvement in quality of life. Conclusions. The 2.5 mg dosage resulted in a lesser reduction in fibroid size but a similar improvement in quality of life when compared to the 5 mg dose. This trial is registered with ClinicalTrials.gov NCT01786226.

Figures

Figure 1
Figure 1
Flow chart for the trial.

References

    1. Chabbert-Buffet N, Meduri G, Bouchard P, Spitz IM. Selective progesterone receptor modulators and progesterone antagonists: mechanisms of action and clinical applications. Human Reproduction Update. 2005;11(3):293–307.
    1. Spitz IM. Mifepristone: where do we come from and where are we going? Clinical development over a quarter of a century. Contraception. 2010;82(5):442–452.
    1. Levens ED, Potlog-Nahari C, Armstrong AY, et al. CDB-2914 for uterine leiomyomata treatment: a randomized controlled trial. Obstetrics and Gynecology. 2008;111(5):1129–1136.
    1. Nieman LK, Blocker W, Nansel T, et al. Efficacy and tolerability of CDB-2914 treatment for symptomatic uterine fibroids: a randomized, double-blind, placebo-controlled, phase IIb study. Fertility and Sterility. 2011;95(2):767.e2–772.e2.
    1. Eisinger SH, Meldrum S, Fiscella K, Le Roux HD, Guzick DS. Low-dose mifepristone for uterine leiomyomata. Obstetrics and Gynecology. 2003;101(2):243–250.
    1. Eisinger SH, Bonfiglio T, Fiscella K, Meldrum S, Guzick DS. Twelve-month safety and efficacy of low-dose mifepristone for uterine myomas. Journal of Minimally Invasive Gynecology. 2005;12(3):227–233.
    1. Fiscella K, Eisinger SH, Meldrum S, Feng C, Fisher SG, Guzick DS. Effect of mifepristone for symptomatic leiomyomata on quality of life and uterine size: a randomized controlled trial. Obstetrics and Gynecology. 2006;108(6):1381–1387.
    1. Carbonell JL, Acosta R, Pérez Y, Campos R, Valle A, Sánchez C. Treatment of uterine myoma with 5 or 10 mg mifepristone daily during 6 months, post-treatment evolution over 12 months. Double blind randomized clinical trial. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2012;16(2):202–208.
    1. Feng C, Meldrum S, Fiscella K. Improved quality of life is partly explained by fewer symptoms after treatment of fibroids with mifepristone. International Journal of Gynecology and Obstetrics. 2010;109(2):121–124.
    1. Carbonell JL, Acosta R, Pérez Y, et al. Safety of 10 versus 5 mg of mifepristone during 9 months for the treatment of uterine fibroids. Double-blind randomized 10 clinical trial. International Journal of Women’s Health. 2013;5:115–124.
    1. Eisinger SH, Fiscella J, Bonfiglio T, Meldrum S, Fiscella K. Open-label study of ultra low-dose mifepristone for the treatment of uterine leiomyomata. European Journal of Obstetrics Gynecology and Reproductive Biology. 2009;146(2):215–218.
    1. Engman M, Granberg S, Williams ARW, Meng CX, Lalitkumar PGL, Gemzell-Danielsson K. Mifepristone for treatment of uterine leiomyoma. A prospective randomized placebo controlled trial. Human Reproduction. 2009;24(8):1870–1879.
    1. Guidance for Industry. Drug-Induced Liver Injury: Premarketting Clinical Evaluation. US Department of Health and Human Services; 2009.
    1. Horne FM, Blithe DI. Progesterone receptor modulators and the endometrium: changes and consequences. Human Reproduction Update. 2007;13(6):567–580.
    1. Mutter GL, Bergeron C, Deligdisch L, et al. The spectrum of endometrial pathology induced by progesterone receptor modulators. Modern Pathology. 2008;21(5):591–598.
    1. Spies JB, Coyne K, Guaou NG, Boyle D, Skyrnarz-Murphy K, Gonzalves SM. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstetrics and Gynecology. 2002;99(2):290–300.
    1. Faul F. G*Power Version 3. 0. 10. Universitat Kiel, Kiel, Germany, 1992–2008.
    1. Carbonell JL, Acosta R, Heredia B, Pérez Y, Yero MC, Valle A. Mifepristone for the treatment of uterine leiomyomas. Obstetrics and Gynecology. 2008;112(5):1029–1036.
    1. Carbonell JL, Rámirez GMQ, Borge A, Zapata LEC, Aragón WC, Tomasi G. Mifepristone 5 mg versus 10 mg daily to treat leiomyoma. Progresos de Obstetricia y Ginecología. 2009;10:1–8.
    1. Carbonell JL, Acosta R, Pérez Y, Yero MC, Seigler I, Heredia B. Evolution of uterine leiomyoma after treatment with mifepristone. Randomized clinical trial. Progresos de Obstetricia y Ginecología. 2010;53(6):231–236.
    1. Carbonell JL, Acosta R, Heredia B, et al. Mifepristone to treat uterine fibroids. Revista Cubana de Ginecologia y Salud Reproductiva. 2010;36(2) .
    1. Carbonell JL, Riverón AM, Cano M, et al. Mifepristone 2. 5 mg versus 5 mg daily in the treatment of leiomyoma before surgery. Randomized clinical trial. International Journal of Women’s Health. 2012;4:75–84.
    1. Bagaria M, Suneja A, Vaid NB, Guleria K, Mishra K. Low-dose mifepristone in treatment of uterine leiomyoma: a randomised double-blind placebo-controlled clinical trial. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2009;49(1):77–83.
    1. Steinauer J, Pritts EA, Jackson R, Jacoby AF. Systematic review of mifepristone for the treatment of uterine leiomyomata. Obstetrics and Gynecology. 2004;103(6):1331–1336.
    1. Fiscella J, Bonfiglio T, Winters P, Eisinger SH, Fiscella K. Distinguishing features of endometrial pathology after exposure to the progesterone receptor modulator mifepristone. Human Pathology. 2011;42(7):947–953.
    1. European Medicine Agency. Committee for medicinal products for human use. Assessment report, Esmya (ulipristal), Procedure EMEA/H/C/002041/0000, 2011.

Source: PubMed

3
Subscribe