Ulipristal vs mifepristone for fibroid treatment. Can anyone elaborate?


1)Mifepristone is a synthetic 19-norsteroid SPRM with primarily PR antagonist activity, and it was one of the first SPRMs to be developed and commonly utilized. Although mifepristone is most commonly recognized as RU-486, an antiprogesterone used as an abortifacient, it also exhibits inhibitory effects on uterine fibroid growth . A randomized controlled trial in 2009 assessed patients treated with mifepristone compared with placebo and noted a significant reduction in uterine size, resolution of anemia, and improvement in symptoms of menorrhagia . A subsequent Cochrane review of 3 randomized controlled trials evaluating mifepristone for the treatment of symptomatic fibroids demonstrated significantly reduced bleeding and improved quality of life in users of mifepristone, but no significant reduction in fibroid volume . Therefore, mifepristone was not recommended on the basis of this systematic review until better-powered randomized controlled trials were conducted.2)UPA, CDB-2914 is a synthetic steroid derived from 19-norprogesterone . which is a selective PR modulator that binds to PR-A and PR-B with high affinity . The binding and antagonist potency of UPA with the glucocorticoid receptor is significantly reduced compared to mifepristone. UPA is tissue selective, with preferential binding noted in the uterus, cervix, ovaries, and hypothalamus 3)PEARL I compared UPA at a dosage of 5 and 10 mg/day with placebo for a 13-week treatment period. It effectively controlled uterine bleeding and reduced the size of fibroids, as measured by MRI compared with placebo. Rates of amenorrhea were high in women treated with UPA, occurring very early, achieved within the first 10 days after initiation of treatment 4)PEARL II was a double-blinded, noninferiority trial that included 307 patients randomly assigned to 5 or 10 mg of UPA vs. a GnRH agonist, depot leuprolide acetate, for 3 months of treatment .UPA controlled bleeding in nearly 100% of women, and they achieved amenorrhea 2 weeks earlier than women treated with leuprolide. The major benefit of UPA over leuprolide acetate is the reduced -hypoestrogenic side effects and bone loss. These differences between UPA and leuprolide may make UPA a preferred choice for preoperative adjuvant therapy (10% vs. 40% in the leuprolide acetate group, P<0.001).5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854898/

Sir, are they both widely being used for fibroid management?

View 2 other replies

Diseases Related to Discussion

Cases that would interest you