Oral Gonadotropin-Releasing Hormone Antagonist Relugolix Compared With Leuprorelin Injections for Uterine Leiomyomas A Randomized Controlled Trial  

Yvonne Rice Fertility, Surgery

Every year we are required as part of our board certification to read a large number of scientific articles with questions.  This article is on our list for 2019.  Now Both relugolix and AbbVie’s elagolix are oral drugs that do the same thing as Lupron, an injectable drug that has been around since the late 1980’s.  I have been in practice for 25 years and aside from a few patients in the early days of my practice (early 90’s) where I tried this drug to shrink the fibroids, I have never found a use for the drug clinically.  As a therapy for fibroids, the only realistic use I would find would be in the severely anemic woman with continued blood loss in an attempt to temporarily stop bleeding to allow the blood count to recover before surgery to remove the fibroids.  With careful attention to blood loss at surgery, we just never seem to need this indication with our patients and in my early experience with the drug, about half of women bled worse on the drug.  Furthermore, it drops estrogen to menopausal levels and causes a cadre of terrible side effects including hot flashes, night sweats, sleep disturbance etc.  The drug can not be used more than 6 months, so when the drug is discontinued the fibroids become metabolically active, bleed and quickly grow back to their original size.  Sounds great?

Fast forward to 2019, and essentially the same drug with the same mechanism only now oral is being studied????  Why is that and why do we need another drug.  The bottom line is it’s business and the studies are funded by the drug company making the drug.  I wonder what the outcome will look like?  In any event with 25 years experience in dealing with fibroids for patients, these drugs are not necessary and surgery is the best option for symptomatic fibroids.  These drugs just are an expensive and misery producing way to put off surgery to a later date.  Lupron for an injection covering 3 months of suppression ranges from $4000 to $7500 a dose so two doses could cost $15,000 for something that really doesn’t help.  Where’s the benefit – the drug company.  Now drug companies are not inherently bad but in some cases our society is spending Billions just to get drugs out in the marketplace that really don’t add to the health of our society.  These drugs fit that category.

On a positive note, these new oral drugs could be a great help for our fertility patients stimulation cycles, replacing Lupron with an oral drug that would be less invasive and actually is a little less costly.  That is where these drugs should be studied and marketed.  Just my editorial.

Michael D. Fox, MD

Advanced Reproductive Specialists

https://www.ncbi.nlm.nih.gov/m/pubmed/30741797/