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Oral Gonadotropin-Releasing Hormone Antagonist Relugolix Compared With Leuprorelin Injections for Uterine Leiomyomas

A Randomized Controlled Trial

Osuga, Yutaka, MD, PhD; Enya, Kazuaki, MPharm; Kudou, Kentarou, MSc; Tanimoto, Masataka, BPharm; Hoshiai, Hiroshi, MD, PhD

doi: 10.1097/AOG.0000000000003141
Contents: Leiomyomas: Original Research
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OBJECTIVE: To investigate the noninferiority of relugolix compared with leuprorelin acetate in reducing heavy menstrual bleeding associated with uterine leiomyomas.

METHODS: In a double-blind, double-dummy trial, premenopausal women with uterine leiomyomas and heavy menstrual bleeding defined as a pictorial blood loss assessment chart score of at least 120 were randomized in a 1:1 ratio to relugolix (40 mg, oral, once daily) or leuprorelin acetate (1.88 mg or 3.75 mg, monthly injection) for 24 weeks. The primary endpoint was the proportion of patients with a total pictorial blood loss assessment chart score of less than 10 for weeks 6–12. Secondary endpoints included myoma and uterine volumes, and hemoglobin levels. A sample size of 144 patients per group (n=288) was estimated to provide at least 90% power to demonstrate noninferiority (prespecified noninferiority margin −15%; one-sided 0.025 level of significance).

RESULTS: From March 2016 to September 2017, 281 patients were randomized (relugolix, n=139, leuprorelin n=142). Demographic and baseline characteristics were well balanced; mean pictorial blood loss assessment chart score was 254.3 in the relugolix group and 263.7 in the leuprorelin group. The proportion of patients with total pictorial blood loss assessment chart score of less than 10 for weeks 6–12 was 82.2% in the relugolix group and 83.1% in the leuprorelin group, demonstrating noninferiority of relugolix compared with leuprorelin (relugolix−leuprorelin difference −0.9%; 95% CI: −10.10 to 8.35; prespecified noninferiority margin −15%; P=.001). Reductions in myoma and uterine volumes and increases in hemoglobin levels were comparable in the two groups. Relugolix was associated with an earlier effect on menstrual bleeding than leuprorelin (pictorial blood loss assessment chart score of less than 10, 64.2% vs 31.7% [relugolix−leuprorelin difference 32.5%; 95% CI: 20.95–44.13%] for weeks 2–6 and pictorial blood loss assessment chart score of 0, 52.6% vs 21.8% [30.7%; 95% CI: 19.45–42.00%] for weeks 2–6) and faster recovery of menses after treatment discontinuation (relugolix median [Q1, Q3], 37 days [32.0, 46.0]; leuprorelin median, 65 days [54.0, 77.0]). Adverse events and bone mineral density loss were similar between relugolix and leuprorelin treatment groups.

CONCLUSION: In women with uterine leiomyomas, once-daily treatment with relugolix, an oral gonadotropin-releasing hormone antagonist, demonstrated noninferiority to monthly leuprorelin for improvement of heavy menstrual bleeding at 6–12 weeks of treatment, had a more rapid effect on menstrual bleeding, and was generally well tolerated.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02655237; JAPIC Clinical Trial Information, JapicCTI-163128.

FUNDING SOURCE: Takeda Pharmaceutical Company Limited and an affiliate of NovaQuest Capital Management LLC.

Relugolix, an oral gonadotropin-releasing hormone antagonist, is noninferior to leuprorelin acetate in reducing leiomyoma-associated heavy menstrual bleeding at 6–12 weeks of treatment.

Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; and Takeda Pharmaceutical Company Limited, and Kindai University, Osaka, Japan.

Corresponding author: Kazuaki Enya, MPharm, Takeda Development Center Japan, Takeda Pharmaceutical Company Limited, 1–1 Doshomachi 4-chome, Chuo-ku, Osaka 540-8645, Japan; email: kazuaki.enya@takeda.com.

This study was sponsored by Takeda Pharmaceutical Company Limited, manufacturer and licensee of relugolix (TAK-385), under the codevelopment agreement with an affiliate of NovaQuest Capital Management L.L.C. Medical writing assistance was provided by Tania Dickson, PhD, CMPP and Serina Stretton, PhD, CMPP of ProScribe—Envision Pharma Group, and was funded by Takeda Pharmaceutical Company Limited. ProScribe's medical writing and editing services complied with international guidelines for Good Publication Practice (GPP3).

Financial Disclosure Yutaka Osuga has received research funding from ASKA Pharmaceutical Co., Ltd., Mochida Pharmaceutical Co., Ltd., and Takeda Pharmaceutical Company Limited, has participated in advisory panels for Mochida Pharmaceutical Co., Ltd., and Takeda Pharmaceutical Company Limited, and has participated in speaker's bureaus for Mochida Pharmaceutical Co., Ltd. Kazuaki Enya, Kentarou Kudou, and Masataka Tanimoto are employees of Takeda Pharmaceutical Company Limited. Hiroshi Hoshiai has participated in advisory panels for Takeda Pharmaceutical Company Limited.

Presented at the 70th Annual Congress of the Japan Society of Obstetrics and Gynecology, May 11–13, 2018, Aobayama, Aoba-ku, Sendai, Japan.

Peer reviews are available at http://links.lww.com/AOG/B287.

The authors have confirmed compliance with the journal's requirements for authorship.

Received June 21, 2018

Received in revised form September 21, 2018

Accepted December 20, 2018

© 2019 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.