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Future Perspectives in the Medical Treatment of Endometriosis

Ferrero, Simone MD*; Abbamonte, Luiza Helena MD†; Anserini, Paola MD*; Remorgida, Valentino MD*; Ragni, Nicola MD‡

Obstetrical & Gynecological Survey: December 2005 - Volume 60 - Issue 12 - pp 817-826
CME Program: CATEGORY 1 CME REVIEW ARTICLES 34, 35 AND 36: CME Review Article 35

In the last few years, our understanding of the pathogenesis of endometriosis at the cellular and molecular levels has improved significantly. This may give us the opportunity to use new, specific agents for the treatment of this disorder. Despite the effectiveness of the available treatments, novel therapeutic strategies may improve our ability to eliminate endometriotic lesions when present and to prevent the recurrence of endometriosis after surgical treatment. This review focuses on the new, experimental approaches to the medical treatment of endometriosis and its symptoms. The blockage of aromatase activity in endometriotic lesions with an aromatase inhibitor may represent a new step in the medical treatment of endometriosis. Preliminary clinical studies have demonstrated the efficacy of third-generation nonsteroidal aromatase inhibitors (ie, anastrozole and letrozole) in reducing the intensity of pain symptoms associated with the presence of endometriosis. The new selective progesterone receptor modulators may represent a valid hormonal treatment option. Therapeutic manipulation of the immune system through TNFα inhibitors may be beneficial in women with endometriosis. New pharmaceutical agents affecting inflammation, angiogenesis, and matrix metalloproteinase activity may prevent or inhibit the development of endometriosis. Further clinical trials may determine if these new therapies are superior to current medical treatment strategies for endometriosis.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the reader should be able to describe the new experimental medical treatments of endometriosis, state that the clinical use of nonsteroidal aromatase inhibitors for endometriosis appears to be efficacious but is based on preliminary clinical data, and recall that the drugs used for endometriosis in the future may include manipulation of the immune system.

*Obstetrician/Gynecologist, †Resident, and ‡Professor, Department of Obstetrics and Gynaecology, San Martino Hospital, University of Genoa, Genoa, Italy

Chief Editor's Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credit hours can be earned in 2005. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.

The authors have disclosed that anastrozole, letrozole, mifepristone, pentoxifylline, interferon α2b, leflunomide, etanercept, infliximab, indomethacin, sulindac, rosiglitazone, thalidomide, GnRH antagonists, probucol, and simvastatin have not been approved by the U.S. Food and Drug Administration for use in the treatment of endometriosis. Please consult product labelling for the approved usage of this drug.

The authors have disclosed that onapristone, ZK 136799, Asoprisnil, loxoribine, recombinant human TNF binding protein-1, interleukin-12, Endostatin, TNP-470, antihuman vascular endothelial growth factor-A, TNP-470, Anginex, marimastat, CGS 27023A, Prinomastat, Tanomastat, ONO-4817, TIMP-1, MMP inhibitor III, ERB-041, mevastatin, and mevalonic acid have not been approved by the U.S. Food and Drug Administration.

Wolters Kluwer Health has identified and resolved all faculty conflicts of interest regarding this educational activity.

Reprint requests to: Simone Ferrero, MD, Department of Obstetrics and Gynaecology, San Martino Hospital, University of Genoa, Largo R. Benzi 1, 16132 Genoa, Italy. E-mail: simone.ferrero@fastwebnet.it.

© 2005 Lippincott Williams & Wilkins, Inc.