RESUMO
Objective To provide novel insights into the clinical treatment of adenomyosis. Methods Two hundred patients with adenomyosis were enrolled in this prospective, nonrandomized, parallel-controlled study with a 1-year follow-up in our hospital. Group 1 was treated with 3.75 mg leuprorelin acetate (LA) (n = 40), Group 2 was treated with 1.88 mg LA (n = 40), Group 3 underwent Mirena implantation (n = 40), Group 4 underwent Mirena implantation after treatment with 3.75 mg LA (n = 40), Group 5 underwent Mirena implantation after treatment with 1.88 mg LA (n = 20), and Group 6 received San-Jie-Zhen-Tong capsules alone (n = 20). Uterine volume, pain, cancer antigen 125 level, ovary function, adverse effects, and Mirena expulsion were evaluated. Results The uterine volume and pain scores were lower in the groups treated with 1.88 than 3.75 mg LA, but the lower dose was associated with significantly fewer hot flashes and sweating. The 1-year Mirena expulsion rate was higher in Group 3 than in Groups 4 and 5 (10.00% vs. 3.33%, respectively). Costs were significantly higher in Groups 1 and 4 than in Groups 2 and 5. Conclusion Administration of 1.88 mg LA may be an alternative therapy for Asian patients with adenomyosis. The combination of LA and Mirena could enhance the therapeutic effect. Registration number: ChiCTR-IPR-15005971.
Assuntos
Adenomiose/tratamento farmacológico , Adenomiose/economia , Adulto , Custos e Análise de Custo , Feminino , Humanos , Leuprolida/efeitos adversos , Leuprolida/economia , Leuprolida/uso terapêutico , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Útero/patologiaRESUMO
BACKGROUND: Recent studies suggest that androgen deprivation therapy (ADT) is associated with increased cardiovascular (CV) risk for patients with hormone-sensitive prostate cancer (PCa) and pre-existing CV disease. This risk seems to be different for the gonadotropin-releasing hormone (GnRH) agonists leuprolide and goserelin and GnRH antagonists, whereas the slightly more expensive GnRH antagonist shows a beneficial risk profile. The present study assesses the cost effectiveness of degarelix compared to leuprolide for PCa patients with increased CV risk. METHODS: This analysis is based on a pooled analysis of six phase III, randomized, controlled trials comparing the GnRH agonists leuprolide and goserelin with the GnRH antagonist degarelix. For the combined endpoint of CV events or death a superiority of degarelix was determined with a Number-Needed-to-Treat of 12. From the perspective of German statutory health insurance, this evaluation estimates and compares the additional drug costs of degarelix treatment to the cost of one (avoided) CV event. The CV event costs were estimated via emergency treatment and transportation, inpatient treatment, and rehabilitation. The difference of these two cost pools divided by 12 yields the average saving per patient and year. RESULTS: For every 12 PCa patients with CV history that are treated with GnRH antagonists to prevent one CV event, there will be additional drug costs in comparison with leuprolide treatment of 3111 per year. Costs of 8447 per year are prevented. Therefore, each patient with a history of CV who is treated with degarelix instead of a leuprolide generates savings of 445 per patient and year. CONCLUSIONS: Compared to leuprolide, degarelix is cost effective for patients with increased CV risk.
Assuntos
Doenças Cardiovasculares/induzido quimicamente , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Leuprolida/economia , Leuprolida/uso terapêutico , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/economia , Antineoplásicos Hormonais/efeitos adversos , Antineoplásicos Hormonais/economia , Antineoplásicos Hormonais/uso terapêutico , Análise Custo-Benefício , Humanos , Leuprolida/efeitos adversos , Masculino , Metanálise como Assunto , Oligopeptídeos/efeitos adversos , Oligopeptídeos/economia , Oligopeptídeos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de RiscoAssuntos
Androgênios/metabolismo , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/fisiopatologia , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/fisiopatologia , Antagonistas de Androgênios/efeitos adversos , Anilidas/efeitos adversos , Flutamida/efeitos adversos , Hormônio Liberador de Gonadotropina/agonistas , Humanos , Leuprolida/efeitos adversos , Libido/efeitos dos fármacos , Masculino , Medicare , Metástase Neoplásica , Nitrilas/efeitos adversos , Pênis/efeitos dos fármacos , Pênis/fisiopatologia , Neoplasias da Próstata/complicações , Compostos de Tosil/efeitos adversos , Estados UnidosRESUMO
Suppressing sex hormones in women for 1 wk reduces resting energy expenditure (REE). The effects of more chronic suppression on REE and other components of total energy expenditure (TEE), and whether the reduction in REE is specifically due to loss of estradiol (E2), are not known. We compared the effects of 5 mo of sex hormone suppression (gonadotropin releasing hormone agonist therapy, GnRHAG) with placebo (PL) or E2 add-back therapy on REE and the components of TEE. Premenopausal women received GnRHAG (leuprolide acetate 3.75 mg/mo) and were randomized to receive transdermal therapy that was either E2 (0.075 mg/d; n = 24; means ± SD, aged = 37 ± 8 yr, BMI = 27.3 ± 6.2 kg/m(2)) or placebo (n = 21; aged = 34 ± 9 yr, BMI = 26.8 ± 6.2 kg/m(2)). REE was measured by using a metabolic cart, and TEE, sleep EE (SEE), exercise EE (ExEE, 2 × 30 min bench stepping), non-Ex EE (NExEE), and the thermic effect of feeding (TEF) were measured by using whole room indirect calorimetry. REE decreased in GnRHAG+PL [mean (95% CI), -54 (-98, -15) kcal/d], but not GnRHAG+E2 [+6 (-33, +45) kcal/d] (difference in between-group changes, P < 0.05). TEE decreased in GnRHAG+PL [-128 (-214, -41) kcal/d] and GnRHAG+E2 [-96 (-159, -32) kcal/d], with no significant difference in between-group changes (P = 0.55). SEE decreased similarly in both GnRHAG+PL [-0.07 (-0.12, -0.03) kcal/min] and GnRHAG+E2 [-0.07 (-0.12, -0.02) kcal/min]. ExEE decreased in GnRHAG+PL [-0.46 (-0.79, -0.13) kcal/min], but not GnRHAG+E2 [-0.30 (-0.65, +0.06) kcal/min]. There were no changes in TEF or NExEE in either group. In summary, chronic pharmacologic suppression of sex hormones reduced REE and this was prevented by E2 therapy.
Assuntos
Metabolismo Energético/efeitos dos fármacos , Estradiol/farmacologia , Hormônio Liberador de Gonadotropina/agonistas , Leuprolida/efeitos adversos , Treinamento Resistido , Adulto , Composição Corporal , Densidade Óssea , Método Duplo-Cego , Exercício Físico , Feminino , Humanos , Pessoa de Meia-Idade , Pré-Menopausa , Adulto JovemRESUMO
OBJECTIVE: To identify whether veterans receiving androgen-deprivation therapy (ADT) are screened at any time by bone mass measurement. DESIGN: Cross-sectional study. SETTING: Veterans Administration Tennessee Valley Healthcare System (VA-TVHS). PATIENTS: All male veterans who received at least one dose of goserelin or leuprolide within the fiscal years October 1, 2005, through September 30, 2009. INTERVENTIONS: Data from patients' charts were extracted for demographic information (race, age, and weight prior to the initial injection); date of initiation of therapy; the use of calcium, vitamin D, bisphosphonate, or calcitonin therapy; and documented bone-mineral density testing. MAIN OUTCOME MEASURE: To determine whether veterans receiving ADT with goserelin or leuprolide for prostate cancer were screened at any time for BMD more or less than rates as documented in previous literature. RESULTS: 22.8% of veterans were screened for BMD, which was statistically significant when compared with results found in previous literature. CONCLUSION: Although rates of BMD testing were higher at VA-TVHS compared with previous literature, this rate is still low given the well-known risk of accelerated osteoporosis associated with ADT.
Assuntos
Androgênios/deficiência , Antineoplásicos Hormonais/efeitos adversos , Antineoplásicos Hormonais/uso terapêutico , Gosserrelina/efeitos adversos , Leuprolida/efeitos adversos , Osteoporose/induzido quimicamente , Idoso , Antagonistas de Androgênios/efeitos adversos , Antagonistas de Androgênios/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Estudos Transversais , Gosserrelina/uso terapêutico , Humanos , Leuprolida/uso terapêutico , Masculino , Osteoporose/metabolismo , Neoplasias da Próstata/tratamento farmacológico , Medição de Risco , VeteranosAssuntos
Antineoplásicos Hormonais/uso terapêutico , Leuprolida/uso terapêutico , Neoplasias da Próstata/tratamento farmacológico , Antineoplásicos Hormonais/efeitos adversos , Antineoplásicos Hormonais/economia , Implantes de Medicamento , Humanos , Leuprolida/efeitos adversos , Leuprolida/economia , MasculinoRESUMO
Prostatic carcinoma and its treatment have been associated with adverse effects on health-related quality of life (HRQoL). Individual differences in appraisal and coping have been suggested to mediate these HRQoL outcomes. A randomized trial of 65 men with non-localized prostate cancer compared several treatments and tested associations between appraisal, coping, and HRQoL. These patients, and 16 community volunteers matched for age and general health, undertook psychosocial assessments before treatment and after 6 months of treatment. Compared with baseline assessments, men on hormonal treatments reported impaired sexual function. Groups did not differ on emotional distress, existential satisfaction, subjective cognitive function, physical symptoms, or social and role functioning. For individuals, hormonal treatments were more frequently associated with decreased sexual, social and role functioning, but were also associated with improved physical symptoms. In hierarchical regression analysis, HRQoL was lower for men who had more comorbid illnesses, a history of neurological dysfunction, higher threat appraisals, or higher use of coping strategies at baseline. These results showed that pharmacological hormonal ablation for prostate cancer can improve or decrease HRQoL in different domains. HRQoL in men with prostate cancer was associated more strongly with appraisal and coping than with medical variables.
Assuntos
Adaptação Psicológica , Antagonistas de Androgênios/efeitos adversos , Antineoplásicos Hormonais/efeitos adversos , Hormônio Liberador de Gonadotropina/análogos & derivados , Neoplasias da Próstata/psicologia , Qualidade de Vida/psicologia , Papel do Doente , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Androgênios/administração & dosagem , Antineoplásicos Hormonais/administração & dosagem , Acetato de Ciproterona/administração & dosagem , Acetato de Ciproterona/efeitos adversos , Disfunção Erétil/induzido quimicamente , Disfunção Erétil/psicologia , Hormônio Liberador de Gonadotropina/administração & dosagem , Hormônio Liberador de Gonadotropina/efeitos adversos , Gosserrelina/administração & dosagem , Gosserrelina/efeitos adversos , Humanos , Leuprolida/administração & dosagem , Leuprolida/efeitos adversos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Neoplasias da Próstata/tratamento farmacológicoRESUMO
GnRH Analogues therapy of estrogen-dependent gynaecological diseases aims at suppression of physiologic ciclic ovaric function producing a hypogonadotropic condition. The first consequence of GnRH Analogues administration is hypoestrogenism; this condition permits the disease regression but, on the other, it causes a negative impact on bone metabolism particularly for prolonged therapeutic schemes (6 months). This study has evaluated the faculty of bone mass protection combining GnRH Analogues therapy with Ipriflavone that stimulates, both "in vivo" and "in vitro", Osteoblastic cells activity. The result of this study showed a significant bone loss in patients treated with GnRH Analogues only. The Ipriflavone association prevented bone loss.
Assuntos
Antineoplásicos Hormonais/efeitos adversos , Reabsorção Óssea/prevenção & controle , Isoflavonas/uso terapêutico , Leuprolida/efeitos adversos , Adulto , Reabsorção Óssea/induzido quimicamente , Feminino , HumanosRESUMO
OBJECTIVES: This is the first multicenter, double-blind randomized clinical trial that compares a depot gonadotropin-releasing hormone agonist with danazol in the treatment of endometriosis. Efficacy results have been previously reported; this report focuses on safety data. STUDY DESIGN: A total of 270 patients from 22 centers were randomly selected to receive either leuprolide acetate depot (3.75 mg injected monthly) or danazol (800 mg administered orally daily). Safety outcomes included adverse effects, clinical laboratory changes, and bone mineral density changes. RESULTS: Most patients receiving either drug reported side effects, most of which were related to the hypoestrogenism of leuprolide (e.g., vasodilatation) and relative hyperandrogenism of danazol (e.g., weight gain). Similarly small numbers of patients dropped out of the two treatment groups because of the side effects encountered. Leuprolide depot caused a greater decrease in bone density; preliminary data suggest a return to baseline on cessation of the drug. Danazol was associated with alteration of serum lipids, specifically a significant decrease in high-density lipoprotein. CONCLUSIONS: Although side effects were commonly reported in both groups, the drugs were similarly safe in terms of the absence of serious complications and the results of cessation of therapy. Side effects were largely reversible on discontinuation of medication. More longitudinal data are necessary before the possibility of long-term risks can be excluded, especially as they pertain to bone mineral density and lipids.