Rapid reduction of leiomyoma volume during treatment with the GnRH antagonist ganirelix.
OBJECTIVE
To assess maximal volume reduction of leiomyomas and uterus and the duration of treatment required to reach these reductions with daily GnRH antagonist treatment.


METHODS
Prospective, open-label study.


METHODS
Large teaching hospital in The Netherlands.


METHODS
Premenopausal women with symptomatic fibroids, who were scheduled for surgery.


METHODS
Twenty women were treated with daily 2 mg of subcutaneous ganirelix. Prior to the first injection and weekly during treatment, the volume of leiomyomas and the uterus were assessed by ultrasound (USS) and serum hormones were measured. Prior to treatment and when maximal size reduction was observed by USS, the volume of the leiomyomas and the uterus were also assessed by magnetic resonance imaging (MRI).


METHODS
Leiomyoma and uterine size reduction, time to maximal reduction.


RESULTS
One woman was excluded from the study due to incorrect administration dose of ganirelix. Data on the remaining 19 women (average age 39 years) with subserosal (n= 9), submucosal (n= 7), intramural (n= 10) and transmural (n= 1) leiomyomas were evaluated. Baseline leiomyoma volumes ranged from small (3-4 mL) to large (>1000 mL). The median duration of treatment up to maximal leiomyoma size reduction was 19 days (range 1-65 days). The maximal size reduction in leiomyomas measured by USS was -42.7% (-77.0% to 14.1%) and -29.2% (-62.2% to 35.6%) by MRI. Comparable uterine size reductions of -46.6% (-78.6% to -6.1%) and -25.2% (-63.6% to 28.9%) were observed by USS and MRI. During the first three weeks of treatment, 8 out of 19 women reported adverse events related to the induced hypoestrogenic state. Most of these events resolved within one week after treatment was discontinued.


CONCLUSIONS
Daily treatment with 2 mg of ganirelix results in rapid reduction of leiomyoma and uterine volume in premenopausal women with minor side effects. If longer-acting GnRH antagonists become available, pretreatment with GnRH antagonist should be preferred over GnRH agonists prior to surgery.
Flierman
P A
PA
Department of Gynaecology, Obstetrics and Reproductive Medicine, OLVG, Amsterdam, The Netherlands.
Oberyé
J J L
JJ
van der Hulst
V P M
VP
de Blok
S
S
D000328:Adult; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors*; D006727:Hormone Antagonists / Q000008:administration & dosage*; D006728:Hormones / Q000097:blood; D006801:Humans; D007271:Injections, Intradermal; D007889:Leiomyoma / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D017697:Premenopause; D011446:Prospective Studies; D014594:Uterine Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology
D006727:Hormone Antagonists; D006728:Hormones; D007987:Gonadotropin-Releasing Hormone; C061018:ganirelix