Treatment of Uterine Myoma with 2.5 or 5 mg Mifepristone Daily during 3 Months with 9 Months Posttreatment Followup: Randomized Clinical Trial.

Objectives. To evaluate the efficacy, safety, and quality of life by using 2.5 and mifepristone 5 mg daily doses to treat uterine fibroids over 3 months with a 9-month followup period. Design. Randomized clinical trial. Place. "Eusebio Hernández" Hospital, Havana, Cuba. Subjects. 220 women with symptomatic uterine fibroids. Treatment. One-half (2.5 mg) or one-whole 5 mg mifepristone tablet. Variables to Evaluate Efficacy. Changes in fibroid and uterine volumes, in symptomatic prevalence and intensity, and in quality of life. Results. After 3-month treatment, fibroid volume decreased by 27.9% (CI 95% 20-35) and 45.5% (CI 95% 37-62), in the 2.5 and 5 mg groups, respectively, P = 0.003. There was no difference in the prevalence of symptoms at the end of treatment, unlike after 6- and 9-month followup when there was a difference. Amenorrhea was significantly higher in the 5 mg group, P = 0.001. There were no significant differences in mifepristone side effects between the groups. Both groups displayed a similar improvement in quality of life. Conclusions. The 2.5 mg dosage resulted in a lesser reduction in fibroid size but a similar improvement in quality of life when compared to the 5 mg dose. This trial is registered with ClinicalTrials.gov NCT01786226.

Mifepristone versus placebo to treat uterine myoma: a double-blind, randomized clinical trial.

OBJECTIVE: To evaluate the efficacy, safety, and quality of life of 5 mg mifepristone per day compared with a placebo in treating uterine fibroids. DESIGN: Randomized, double-blind clinical study. LOCATION: Eusebio Hernández Gynecology and Obstetrics Teaching Hospital, Havana, Cuba. SUBJECTS: One hundred twenty-four subjects with symptomatic uterine fibroids. TREATMENT: One daily capsule of 5 mg mifepristone or a mifepristone placebo over 3 months. VARIABLES IN EVALUATING SAFETY: Changes in fibroid and uterine volumes, changes in symptom prevalence and intensity, and changes in quality of life. RESULTS: Three months into treatment, fibroid volume was reduced by 28.5% in the mifepristone group with an increase of 1.8% in the placebo group (P = 0.031). There were significant differences between the groups with respect to pelvic pain prevalence (P = 0.006), pelvic pressure (P = 0.027), rectal pain (P = 0.013), hypermenorrhea (P < 0.001), and metrorrhagia (P = 0.002) at the end of treatment. Amenorrhea was 93.1% and 4.3% in the mifepristone and placebo groups, respectively (P < 0.001). Treatment side effects were significantly greater in the mifepristone group. Estradiol levels did not differ significantly between the placebo and mifepristone groups at the end of treatment. Improvement in quality of life was significantly greater in the categories of "symptoms" (P = 0.004) and "activity" (P = 0.045) in the mifepristone group. CONCLUSION: The 5 mg dosage of mifepristone presented significantly superior efficacy compared to the placebo.

Safety and effectiveness of different dosage of mifepristone for the treatment of uterine fibroids: a double-blind randomized clinical trial.

OBJECTIVES: The aim of this study was to evaluate the safety and improvement in quality of life using 10 mg and 5 mg daily doses of mifepristone for the treatment of uterine fibroids. DESIGN: The research was a randomized double-blind clinical study undertaken at the Eusebio Hernández Hospital in Havana, Cuba. SUBJECTS AND METHODS: Seventy subjects with symptomatic uterine fibroids took one daily capsule of 10 mg or 5 mg mifepristone orally for 9 months. One to three endometrial biopsies were performed. In evaluating safety, the variables studied were endometrial changes associated with mifepristone, elevation of hepatic transaminases, side effects of mifepristone, and instances and duration of irregular bleeding. RESULTS: There were 30/49 (61.2%) and 13/24 (54.2%) diagnoses of endometrial changes associated with mifepristone in the 10 mg and 5 mg groups, respectively (P = 0.282). At every evaluation visit the average endometrial thickness was significantly greater in the 10 mg group than in the 5 mg group (P = 0.013, P = 0.002, and P = 0.013, respectively). Only five subjects had slight elevations in their hepatic transaminases after 9 months' treatment. Sixteen of 35 (45.7%) and eight of 33 (24.2%) subjects had the occasional hot flush in the 10 mg and 5 mg groups, respectively (P = 0.032). In total, there were 12.9 ± 4.6 (n = 21) and 9.1 ± 3.9 (n = 18) days of irregular bleeding in the 10 mg and 5 mg groups, respectively (P = 0.009). CONCLUSION: According to the study findings, a 5 mg daily dose over 9 months has a relatively better safety profile than the 10 mg dose.

Treatment of uterine myoma with 5 or 10mg mifepristone daily during 6 months, post-treatment evolution over 12 months: double-blind randomised clinical trial.

OBJECTIVES: To evaluate the efficacy and safety of 5 and 10mg doses of mifepristone for 6 months for the treatment of uterine fibroids and to check those results at 1 year post-treatment. STUDY DESIGN: Randomised double-blind clinical study carried out at the "Eusebio Hernández" Hospital, Havana, Cuba. One hundred and seventy-six women with symptomatic uterine fibroids received one daily capsule of 10mg mifepristone orally or one daily capsule of 5mg mifepristone orally, over 6 months. Up to two endometrial biopsies were performed. Reduction in fibroid volume was used to evaluate efficacy. RESULTS: The 5 and 10mg dose had a similar efficacy in reducing the fibroid volume, 48.1% and 39.1%, p=0.07, and that of the uterus, 30.3% and 27.2%, p=0.63, respectively. Twelve months after treatment the majority of the subjects were asymptomatic with symptom prevalence similar to that at the end of treatment, except for hypermenorrhea and metrorrhagia, although the intensity of hypermenorrhea was much less, p<0.01. CONCLUSIONS: (1) Both doses obtain similar results in reducing fibroid size. (2) Administering 6 months' treatment achieves symptomatic improvement lasting 1 year in a high percentage of cases. (3) More studies need to be carried out with longer treatment and follow-up periods.

Evolución del leiomioma uterino después del tratamiento con mifepristona. Ensayo clínico aleatorizado / Evolution of uterine leiomyoma after treatment with mifepristone. Randomized clinical trial

Objetivos. Evaluar la duración en el tiempo de la disminución de los volúmenes del fibroma, el útero y la sintomatología en mujeres tratadas con mifepristona. Pacientes y métodos. 100 mujeres con fibromatosis uterina sintomática aleatorizadas a recibir 10 o 5mg de mifepristona fueron seguidas por 6 meses postratamiento. Resultados. Seis meses después del tratamiento el tamaño del fibroma fue 19%, un 23% menor que el valor inicial en los grupos de 10 y 5mg de mifepristona, respectivamente, y el volumen del útero fue del 8%, un 17% menor que al inicio en los grupos de 10 y 5mg, respectivamente. La prevalencia de síntomas se mantenía significativamente menor que antes del tratamiento. Conclusiones. Seis meses después de concluido el tratamiento, los tamaños del fibroma y del útero presentan valores cercanos a los iniciales pretratamiento, pero persistía aun una notable mejoría clínica (AU)

Objectives. To evaluate the extent in time of the reduction of uterine and fibroids size in women treated with mifepristone. Patients and methods. One-hundred women who received mifepristone 10 or 5mg for three months were followed-up for six months after treatment termination. Results. Six months after treatment the fibroids mean sizes were 19% and 23% lower than baseline values in 10 and 5mg mifepristone groups, respectively, and mean uterine volumes were 8% and 17% lesser than before treatment in 10 and 5mg groups, respectively. Prevalence of symptoms was still significantly lower than before treatment. Conclusions. Six months after treatment termination the sizes of fibroids and uteri were near to the initial values but a clinical improvement was maintained (AU)

Mifepristona para tratamiento del fibroma uterino / The use of Mifepristone for treatment of the uterine fibroma

OBJETIVOS: Evaluar la eficacia, seguridad y duración de la mejoría clínica en el tiempo de la administración de 5 vs. 10 mg diarios de mifepristona en el tratamiento del fibroma. MÉTODOS: Fueron aleatorizadas a recibir 5 ó 10 mg diarios de mifepristona oral durante 3 meses y fueron seguidas durante 6 meses después, 100 mujeres con fibromatosis uterina sintomática. Se calcularon los volúmenes del fibroma y del útero por ultrasonografÍa abdominal del útero al inicio, al final del tratamiento, 3 y 6 meses después. RESULTADOS: Al final del tratamiento el fibroma se redujo en 38,3 por ciento, p < 0,001, y 47,5 por ciento, p < 0,001, respecto del valor inicial en los grupos de 5 y 10 mg, respectivamente. El volumen del útero se redujo el 27 por ciento (p = 0,001) y 25,1 por ciento (p = 0,001), con respecto al inicio en los grupos de 5 y 10 mg, respectivamente. La prevalencia de los síntomas fue significativamente menor al final de tratamiento y 6 meses después. Seis meses después del tratamiento el tamaño del fibroma era 21, por ciento y 19, por ciento menor que el valor inicial en los grupos de 5 y 10 mg de mifepristona, respectivamente, y el volumen del útero era 2 por ciento y 0,2, por ciento menor que al inicio en los grupos de 5 y 10 mg, respectivamente. No hubo hiperplasia endometrial en ninguno de los grupos de tratamiento. CONCLUSIONES: La dosis de 5 mg tuvo similar eficacia que la de 10 mg y 6 meses después de concluido el tratamiento los tamaños del fibroma y del útero estaban cercanos a los valores pretratamiento, pero se mantenía una notable mejoría clínica (AU)

OBJECTIVES: to evaluate the efficacy, safety and duration improvement obtained over the course of time by administering mifepristone for the treatment of fibroids. METHODS: One hundred women with symptomatic uterine myomas were randomized to receive oral mifepristone 5 or 10 mg daily for 3 months with 6 month post-treatment monitoring. The fibroid and uterus sizes were calculated by means of abdominal ultrasound examination at the beginning and at the end of treatment as well as 3 and 6 months later. RESULTS: At the end of treatment the fibroid decreased in size 38.3 por ciento, p < 0.001, and 47.5 por ciento, p < 0.001, respecting to the initial value in the 5 and 10 mg groups, respectively. The uterine volume decreased 27 por ciento (p = 0.001) and 25.1 por ciento (p = 0.001), regarding to initial values in the 5 and 10 mg groups, respectively. Symptom prevalence was significantly less at the end of treatment and 6 months later. Six months after treatment fibroid size was 21 por ciento and 19 por ciento less than the initial value in the 5 and 10 mg mifepristone groups, respectively, and uterine volume was 2 por ciento and 0.2 por ciento less than initial values in the 5 and 10 mg groups, respectively. There was no endometrial hyperplasia in any of the treatment groups. CONCLUSIONS: The 5 mg dose had an efficacy similar to the 10 mg dosage and 6 months after termination of the treatment fibroid and uterine sizes were close to pre-treatment values but a notable clinical improvement was maintained (AU)

Mifepristona para tratamiento del fibroma uterino / The use of Mifepristone for treatment of the uterine fibroma

OBJETIVOS: Evaluar la eficacia, seguridad y duración de la mejoría clínica en el tiempo de la administración de 5 vs. 10 mg diarios de mifepristona en el tratamiento del fibroma. MÉTODOS: Fueron aleatorizadas a recibir 5 ó 10 mg diarios de mifepristona oral durante 3 meses y fueron seguidas durante 6 meses después, 100 mujeres con fibromatosis uterina sintomática. Se calcularon los volúmenes del fibroma y del útero por ultrasonografÍa abdominal del útero al inicio, al final del tratamiento, 3 y 6 meses después. RESULTADOS: Al final del tratamiento el fibroma se redujo en 38,3 por ciento, p < 0,001, y 47,5 por ciento, p < 0,001, respecto del valor inicial en los grupos de 5 y 10 mg, respectivamente. El volumen del útero se redujo el 27 por ciento (p = 0,001) y 25,1 por ciento (p = 0,001), con respecto al inicio en los grupos de 5 y 10 mg, respectivamente. La prevalencia de los síntomas fue significativamente menor al final de tratamiento y 6 meses después. Seis meses después del tratamiento el tamaño del fibroma era 21, por ciento y 19, por ciento menor que el valor inicial en los grupos de 5 y 10 mg de mifepristona, respectivamente, y el volumen del útero era 2 por ciento y 0,2, por ciento menor que al inicio en los grupos de 5 y 10 mg, respectivamente. No hubo hiperplasia endometrial en ninguno de los grupos de tratamiento. CONCLUSIONES: La dosis de 5 mg tuvo similar eficacia que la de 10 mg y 6 meses después de concluido el tratamiento los tamaños del fibroma y del útero estaban cercanos a los valores pretratamiento, pero se mantenía una notable mejoría clínica

OBJECTIVES: to evaluate the efficacy, safety and duration improvement obtained over the course of time by administering mifepristone for the treatment of fibroids. METHODS: One hundred women with symptomatic uterine myomas were randomized to receive oral mifepristone 5 or 10 mg daily for 3 months with 6 month post-treatment monitoring. The fibroid and uterus sizes were calculated by means of abdominal ultrasound examination at the beginning and at the end of treatment as well as 3 and 6 months later. RESULTS: At the end of treatment the fibroid decreased in size 38.3 por ciento, p < 0.001, and 47.5 por ciento, p < 0.001, respecting to the initial value in the 5 and 10 mg groups, respectively. The uterine volume decreased 27 por ciento (p = 0.001) and 25.1 por ciento (p = 0.001), regarding to initial values in the 5 and 10 mg groups, respectively. Symptom prevalence was significantly less at the end of treatment and 6 months later. Six months after treatment fibroid size was 21 por ciento and 19 por ciento less than the initial value in the 5 and 10 mg mifepristone groups, respectively, and uterine volume was 2 por ciento and 0.2 por ciento less than initial values in the 5 and 10 mg groups, respectively. There was no endometrial hyperplasia in any of the treatment groups. CONCLUSIONS: The 5 mg dose had an efficacy similar to the 10 mg dosage and 6 months after termination of the treatment fibroid and uterine sizes were close to pre-treatment values but a notable clinical improvement was maintained

Mifepristone for the treatment of uterine leiomyomas: a randomized controlled trial.

OBJECTIVE: To estimate the efficacy of daily administration of 5 mg compared with 10 mg of mifepristone for the treatment of uterine myomas. METHODS: One hundred women were randomly assigned to receive oral mifepristone 5 mg or 10 mg daily for 3 months (50 per group). Abdominal ultrasonography was performed before treatment, at 45 days, and at 3 months to evaluate leiomyoma and uterine volumes. Endometrial biopsy specimens were taken before and after treatment. Efficacy was estimated by the reduction percentages of the leiomyoma and uterine volumes. RESULTS: After 90 days treatment there was a 45% (95% confidence interval [CI] 37-54, P<.001) and a 57% (95% CI 48-67, P<.001) reduction in the leiomyoma volume in the 10-mg and 5-mg groups, respectively, and one of 40% (95% CI 34-46, P=.002), and 36% (95% CI 31-40, P<.001), respectively, in the uterine volume. Symptomatic improvement was noted, and the prevalence of symptoms diminished significantly. There were no significant differences in reduction of volume and symptoms in the treatment groups, P>.05 in all cases. After treatment, 44 of 49 (89.8%) women from the mifepristone 10 mg group and 45 of 50 (90.0%) from the 5-mg group, respectively, were amenorrheic (P=.487). Endometrial biopsy after treatment showed simple hyperplasia in 1 of 50 (2.0%) in the mifepristone 10 mg group. CONCLUSION: Five-milligram doses of mifepristone produce reductions in leiomyoma and uterine volumes and symptomatic improvement similar to 10-mg doses. LEVEL OF EVIDENCE: I.

Budd-Chiari-like presentation of hepatic adenoma.

Hepatic adenoma is a benign tumor characterized by its hypervascularity. Hepatic adenoma tends to occur more frequently in women and is related to the use of contraceptive hormones, androgenic/anabolic steroids, pregnancy, glycogen storage diseases and hemochromatosis. Hepatic venous obstruction, or Budd-Chiari syndrome, is a condition of hepatic vein occlusion that has many causes. A 35-year-old woman presented shortly after pregnancy with a huge cystic lesion in the liver. The lesion compressed the hepatic vein and created an early stage of Budd-Chiari syndrome. Tumor resection was carried out successfully. The final diagnosis of this case was multiple hepatic adenomas.