Subcutaneous depot medroxyprogesterone acetate versus leuprolide acetate in the treatment of endometriosis-associated pain.
BACKGROUND
A clinical study compared efficacy and safety of depot medroxyprogesterone acetate (DMPA) with leuprolide for endometriosis-associated pain.


METHODS
This multicentre, 18 month, evaluator-blinded, comparator-controlled trial randomized 300 women with laparoscopically diagnosed endometriosis to 6 month treatment with subcutaneous injection of 104 mg/0.65 ml DMPA (DMPA-SC 104) every 3 months or leuprolide (3.75 mg monthly or 11.25 mg every 3 months), with 12 months post-treatment follow-up. Endpoints included patient response to treatment in five signs/symptoms (dysmenorrhoea, dyspareunia, pelvic pain, pelvic tenderness, induration) and changes in bone mineral density (BMD) and productivity at 6 and 18 months.


RESULTS
DMPA-SC 104 and leuprolide produced equivalent (P < 0.02) reductions in at least four pain categories and significant (P < 0.001) improvements in composite score at months 6 and 18. At month 6, reductions in total hip and lumbar spine BMD were significantly less (P < 0.001) with DMPA-SC 104 versus leuprolide. BMD returned to pre-treatment levels 12 months post-treatment in the DMPA-SC 104 but not the leuprolide group. Total productivity also significantly (P < or = 0.05) improved in both groups at 6 and 18 months.


CONCLUSIONS
DMPA-SC 104 reduces endometriosis-associated pain as effectively as leuprolide and improves productivity with significantly less BMD decline.
Crosignani
P G
PG
I Clinica Ostetrica e Ginecologica - Università di Milano, Via Commenda 12 20122 Milano, Italy.
Luciano
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Ray
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Bergqvist
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A
D000279:Administration, Cutaneous; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage* / Q000009:adverse effects; D015519:Bone Density; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D004715:Endometriosis / Q000188:drug therapy*; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D006615:Hip / Q000000981:diagnostic imaging; D006801:Humans; D016729:Leuprolide / Q000008:administration & dosage* / Q000009:adverse effects; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage* / Q000009:adverse effects; D017699:Pelvic Pain / Q000188:drug therapy*; D011788:Quality of Life; D011859:Radiography; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000188:drug therapy*
D018931:Antineoplastic Agents, Hormonal; D003271:Contraceptive Agents, Female; D005300:Fertility Agents, Female; D017258:Medroxyprogesterone Acetate; D016729:Leuprolide