Emerging therapy for endometriosis

Abstract

Introduction: Endometriosis is a chronic disease manifested by pain and infertility due to ectopic implantation of endometrial glands and stroma causing inflammation. Treatment of endometriosis utilizes a significant amount of health-care resources and requires chronic therapy. Management involves a combination of surgical and medical interventions and requires long-term treatment to avoid repeated surgeries.

Areas covered: Whereas medical therapies exist for management of endometriosis-related pain, each class has its limitations including side effects, cost, and known duration of relief of symptoms. Development of effective, well-tolerated medical therapies that are appropriate for long-term use is crucial to provide adequate treatment for this chronic disease. This review discusses the various medical therapies available, their limitations, and emerging therapies being developed to address many of these concerns.

Expert opinion: The authors recommend chronic suppressive therapy for management of endometriosis symptoms, particularly in the postoperative setting. Empiric treatment is appropriate for those patients without evidence of severe disease. Currently available option may not be effective for nor tolerated by all patients. Newer compounds, including gonadotropin-releasing antagonists and aromatase inhibitors combined with hormonal contraceptives, offer possible alternatives to currently available therapies.

Keywords:

• aromatase inhibitor
• combined hormonal contraceptive
• endometriosis
• gonadotropin-releasing hormone agonist
• gonadotropin-releasing hormone antagonist
• levonorgesterol intrauterine system
• nonsteroidal anti-inflammatory drug
• progesterone antagonist
• progestins
• selective estrogen receptor modulator
• selective progesterone receptor modulator
• vascular endothelial growth factor

Declaration of interest

This work has been partly supported by the Department of Obstetrics and Gynecology of the University of Connecticut Health Center, and the Residency Program of the School of Medicine. A Luciano and D Luciano are the recipients of research grants from AbbVie Pharmaceutical Company and A Luciano has received speaker’s fee from AbbVie, Intuitive Surgical. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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