The short- and mid-term efficacy and safety of elagolix in the management of pain associated with endometriosis: A systematic review and meta-analysis - 03/08/24

Doi : 10.1016/j.jogoh.2024.102829

Yue Zhang, Wei Wei, En Chang, Yan-en Leng, Yi Hou, Xi Wei, Xin Yue, Li Zhong, Jin-feng Liu ^⁎
Department of Pharmacy, People's Hospital of Zhongjiang County, Deyang 618100, Sichuan, China

^⁎Corresponding author at: Department of Pharmacy, People's Hospital of Zhongjiang County, 96 Dabei Street, Zhongjiang County, Deyang 618100, Sichuan Province, China.Department of PharmacyPeople's Hospital of Zhongjiang County96 Dabei Street, Zhongjiang CountyDeyangSichuan Province618100China

Abstract

Background

Elagolix, an approved non-peptide GnRH antagonist, shows promise in relieving endometriosis-related pain, but its short- and mid-term efficacy and potential side effects are still under investigation.

Objective

The aim is to provide data for therapeutic applications by methodically evaluating elagolix's safety and effectiveness in treating endometriosis-related pain.

Methods

Databases such as PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials.gov, and others were thoroughly searched. The search time was from the establishment date to September 2023. The study included randomized controlled trials (RCTs) that compared the efficacy of elagolix versus placebo in treating endometriosis-associated pain. After data extraction and literature scanning, quality assessment was carried out using Quality evaluation was carried out using the bias risk assessment tool suggested by the Cochrane Reviewers' Handbook 5.1.0 after literature screening and data extraction. Stata 15.0 was used to do the meta-analysis.

Results

In total, five RCTs involving 2056 patients were included in the analysis. The meta-analysis demonstrated a significant superiority of elagolix over placebo in the management of endometriosis-related pain, specifically in endometriosis pain [WMD=-0.77, 95% CI (-1.00, -0.53), P<0.001], as well as in non-menstrual pelvic pain, daily assessment of dysmenorrhea (DYS), and dyspareunia (DYSP), all of which are associated with endometriosis. Regarding safety, no discernible variation was observed in the incidence of serious adverse responses between the elagolix and placebo groups [RR=0.90, 95% CI (0.58, 1.40), P=0.643]. Conversely, the elagolix group exhibited a significantly higher incidence rate of general adverse responses [RR = 1.34, 95% CI (1.18, 1.52), P<0.001] compared to the control group.

Conclusions

The efficacy of elagolix in reducing pain in premenopausal women with endometriosis has been demonstrated over the short- to mid-term. However, careful monitoring for potential adverse effects is essential throughout the treatment duration.

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Keywords : Elagolix, Endometriosis, Pain, Meta-analysis

Abbreviations : GnRH, PRISMA, NRS, DYS, NMPP, DYSP, RCT, RR, WMD, NSAIDs, FDA