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Risk factors for non-response and discontinuation of Dienogest in endometriosis patients: A cohort study.

子宫内膜异位症患者无反应和停用Dienogest的危险因素: 一项队列研究。

  • 影响因子:2.21
  • DOI:10.1111/aogs.13969
  • 作者列表:"Nirgianakis K","Vaineau C","Agliati L","McKinnon B","Gasparri ML","Mueller MD
  • 发表时间:2021-01-01
Abstract

INTRODUCTION:Progestins are commonly prescribed first-line drugs for endometriosis. High rates of non-response and intolerance to these drugs have been previously reported. However, no study to date has investigated the characteristics and comorbidities of patients taking progestins in relation to treatment outcomes, so identifying which patients will respond to or tolerate the treatment is currently impossible. The purpose of this study, therefore, was to identify risk factors for non-response and discontinuation of Dienogest (DNG) in women with endometriosis. MATERIAL AND METHODS:This is a retrospective cohort study including women currently taking, or newly prescribed, DNG for endometriosis-associated pain presenting in the Endometriosis Clinic of the University Hospital of Bern between January 2017 and May 2018. Women with initiation of treatment directly after surgery for endometriosis were excluded. For all participants the symptoms and comorbidities were documented. Effectiveness, tolerability and discontinuation of DNG were the primary end points. Univariate and multivariate binary logistic regression models were carried out to identify risk factors for non-response, intolerance and discontinuation of DNG. RESULTS:A sufficient or excellent treatment response was reported by 85/125 (68%) participants. Genital bleeding during the DNG treatment was negatively (OR 0.185, 95% CI 0.056-0.610, P = .006) and rASRM endometriosis stages III and IV were positively (OR 3.876, 95% CI 1.202-12.498, P = .023) correlated with the DNG response. When accounting for exclusively pretreatment factors, primary dysmenorrhea (OR 0.236, 95% CI 0.090-0.615, P = .003) and suspicion of adenomyosis (OR 0.347, 95% CI 0.135-0.894, P = .028) were inversely correlated with DNG response, and the latter was also correlated with treatment discontinuation (OR 3.189, 95% CI 1.247-8.153, P = .015). CONCLUSIONS:Genital bleeding during the DNG treatment and low rASRM stages are independent risk factors for DNG non-response. Before treatment initiation, primary dysmenorrhea and suspicion of adenomyosis correlate with DNG non-response. The results could assist the clinician first to provide detailed information to women before treatment initiation, second to identify and possibly modify in-therapy factors correlated to treatment effectiveness and lastly to switch treatment on time if needed.

摘要

介绍: 孕激素是常用的子宫内膜异位症的一线药物。以前曾报道过对这些药物无反应和不耐受的高发生率。然而,迄今为止,还没有研究调查服用孕激素的患者的特征和合并症与治疗结果的关系,因此确定哪些患者对治疗有反应或耐受治疗目前是不可能的。因此,本研究的目的是确定子宫内膜异位症女性患者无反应和停用Dienogest (DNG) 的危险因素。 材料和方法: 这是一项回顾性队列研究,包括2017年1月至2018年5月间在伯ber大学医院的子宫内膜异位症门诊中出现的目前服用或新处方的DNG治疗子宫内膜异位症相关疼痛的女性。子宫内膜异位症手术后直接开始治疗的妇女被排除在外。记录所有参与者的症状和合并症。DNG的有效性、耐受性和停药是主要终点。进行单因素和多因素二元logistic回归模型,以确定无反应,不耐受和停止DNG的危险因素。 结果: 85/125名 (68%) 参与者报告了充分或极好的治疗反应。DNG治疗期间生殖器出血呈负相关 (OR 0.185,95% CI 0.056-0.610,P = .006),rASRM子宫内膜异位症III期和IV期与DNG反应呈正相关 (OR 3.876,95% CI 1.202-12.498,P = .023)。当仅考虑治疗前因素时,原发性痛经 (OR 0.236,95% CI 0.090-0.615,P = .003) 和怀疑子宫腺肌病 (OR 0.347,95% CI 0.135-0.894,P = .028) 与DNG反应呈负相关,而后者也与治疗中止相关 (OR 3.189,95% CI 1.247-8.153,P = .015)。 结论: DNG治疗期间生殖器出血和低rASRM分期是DNG无反应的独立危险因素。治疗开始前,原发性痛经和怀疑子宫腺肌病与DNG无反应相关。结果可以帮助临床医生首先在治疗开始前向女性提供详细信息,其次确定并可能修改与治疗有效性相关的治疗中因素,最后在需要时及时切换治疗。

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影响因子:2.68
发表时间:2021-02-01
DOI:10.1080/14656566.2020.1814255
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DOI:10.1007/s11033-021-06299-9
作者列表:["Louvrier A","Terranova L","Meyer C","Meyer F","Euvrard E","Kroemer M","Rolin G"]

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