DOI QR코드

DOI QR Code

Dienogest in endometriosis treatment: A narrative literature review

  • Joowon Lee (Department of Obstetrics and Gynecology, Korea University College of Medicine) ;
  • Hyeon Ji Park (Department of Obstetrics and Gynecology, Korea University College of Medicine) ;
  • Kyong Wook Yi (Department of Obstetrics and Gynecology, Korea University College of Medicine)
  • 투고 : 2023.05.12
  • 심사 : 2023.08.09
  • 발행 : 2023.12.31

초록

Endometriosis is characterized by the implantation of endometrial cells outside the uterus. This hormone-dependent disease is highly prevalent among women of reproductive age. Clinical symptoms of endometriosis include dysmenorrhea, pelvic pain, and infertility, which can negatively impact the overall quality of life of those affected. The medical treatment of endometriosis serves as an important therapeutic option, aimed at alleviating pain associated with the condition and suppressing the growth of endometriotic lesions. As such, it is employed as an adjuvant therapy following surgery or an empirical treatment after the clinical diagnosis of endometriosis. Dienogest, a fourth-generation progestin, has received approval for the treatment of endometriosis in many countries. A growing body of evidence has demonstrated its efficacy in managing endometriosis-associated pain, preventing symptoms, and reducing lesion recurrence. In this review, we examine the clinical efficacy, safety, and tolerability of dienogest in treating endometriosis. We also provide updated findings, drawing from clinical studies that focus on the long-term use of this medication in patients with endometriosis.

키워드

참고문헌

  1. Giudice LC, Kao LC. Endometriosis. Lancet 2004;364:1789-99.  https://doi.org/10.1016/S0140-6736(04)17403-5
  2. Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet 2010;27:441-7.  https://doi.org/10.1007/s10815-010-9436-1
  3. Sampson JA. Metastatic or embolic endometriosis, due to the menstrual dissemination of endometrial tissue into the venous circulation. Am J Pathol 1927;3:93-110. 
  4. Wang Y, Nicholes K, Shih IM. The origin and pathogenesis of endometriosis. Annu Rev Pathol 2020;15:71-95.  https://doi.org/10.1146/annurev-pathmechdis-012419-032654
  5. Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 1997;68:585-96.  https://doi.org/10.1016/S0015-0282(97)00191-X
  6. Becker CM, Beaudry P, Funakoshi T, Benny O, Zaslavsky A, Zurakowski D, et al. Circulating endothelial progenitor cells are up-regulated in a mouse model of endometriosis. Am J Pathol 2011;178:1782-91.  https://doi.org/10.1016/j.ajpath.2010.12.037
  7. Du H, Taylor HS. Contribution of bone marrow-derived stem cells to endometrium and endometriosis. Stem Cells 2007;25:2082-6.  https://doi.org/10.1634/stemcells.2006-0828
  8. Signorile PG, Baldi A. Endometriosis: new concepts in the pathogenesis. Int J Biochem Cell Biol 2010;42:778-80.  https://doi.org/10.1016/j.biocel.2010.03.008
  9. Bedaiwy MA, Allaire C, Alfaraj S. Long-term medical management of endometriosis with dienogest and with a gonadotropin-releasing hormone agonist and add-back hormone therapy. Fertil Steril 2017;107:537-48.  https://doi.org/10.1016/j.fertnstert.2016.12.024
  10. Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol 2019;220:354. 
  11. Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al. ESHRE guideline: endometriosis. Hum Reprod Open 2022;2022:hoac009. 
  12. Hirsch M, Begum MR, Paniz E, Barker C, Davis CJ, Duffy J. Diagnosis and management of endometriosis: a systematic review of international and national guidelines. BJOG 2018;125:556-64.  https://doi.org/10.1111/1471-0528.14838
  13. Johnson NP, Hummelshoj L; World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Hum Reprod 2013;28:1552-68.  https://doi.org/10.1093/humrep/det050
  14. Murji A, Biberoglu K, Leng J, Mueller MD, Romer T, Vignali M, et al. Use of dienogest in endometriosis: a narrative literature review and expert commentary. Curr Med Res Opin 2020;36:895-907.  https://doi.org/10.1080/03007995.2020.1744120
  15. Kalaitzopoulos DR, Samartzis N, Kolovos GN, Mareti E, Samartzis EP, Eberhard M, et al. Treatment of endometriosis: a review with comparison of 8 guidelines. BMC Womens Health 2021;21:397. 
  16. Foster RH, Wilde MI. Dienogest. Drugs 1998;56:825-35.  https://doi.org/10.2165/00003495-199856050-00007
  17. Angioni S, Cofelice V, Pontis A, Tinelli R, Socolov R. New trends of progestins treatment of endometriosis. Gynecol Endocrinol 2014;30:769-73.  https://doi.org/10.3109/09513590.2014.950646
  18. Paulo Leonardo-Pinto J, Laguna Benetti-Pinto C, Angerame Yela D. When solving dyspareunia is not enough to restore sexual function in women with deep infiltrating endometriosis treated with dienogest. J Sex Marital Ther 2019;45:44-9.  https://doi.org/10.1080/0092623X.2018.1474411
  19. Schindler AE. Dienogest in long-term treatment of endometriosis. Int J Womens Health 2011;3:175-84.  https://doi.org/10.2147/IJWH.S5633
  20. Bizzarri N, Remorgida V, Leone Roberti Maggiore U, Scala C, Tafi E, Ghirardi V, et al. Dienogest in the treatment of endometriosis. Expert Opin Pharmacother 2014;15:1889-902.  https://doi.org/10.1517/14656566.2014.943734
  21. Kohler G, Faustmann TA, Gerlinger C, Seitz C, Mueck AO. A dose-ranging study to determine the efficacy and safety of 1, 2, and 4mg of dienogest daily for endometriosis. Int J Gynaecol Obstet 2010;108:21-5.  https://doi.org/10.1016/j.ijgo.2009.08.020
  22. Harada T, Momoeda M, Taketani Y, Aso T, Fukunaga M, Hagino H, et al. Dienogest is as effective as intranasal buserelin acetate for the relief of pain symptoms associated with endometriosis: a randomized, double-blind, multicenter, controlled trial. Fertil Steril 2009;91:675-81.  https://doi.org/10.1016/j.fertnstert.2007.12.080
  23. Sasagawa S, Shimizu Y, Kami H, Takeuchi T, Mita S, Imada K, et al. Dienogest is a selective progesterone receptor agonist in transactivation analysis with potent oral endometrial activity due to its efficient pharmacokinetic profile. Steroids 2008;73:222-31.  https://doi.org/10.1016/j.steroids.2007.10.003
  24. Vercellini P, Fedele L, Pietropaolo G, Frontino G, Somigliana E, Crosignani PG. Progestogens for endometriosis: forward to the past. Hum Reprod Update 2003;9:387-96.  https://doi.org/10.1093/humupd/dmg030
  25. Miyashita M, Koga K, Takamura M, Izumi G, Nagai M, Harada M, et al. Dienogest reduces proliferation, aromatase expression and angiogenesis, and increases apoptosis in human endometriosis. Gynecol Endocrinol 2014;30:644-8.  https://doi.org/10.3109/09513590.2014.911279
  26. Nakamura M, Katsuki Y, Shibutani Y, Oikawa T. Dienogest, a synthetic steroid, suppresses both embryonic and tumor-cell-induced angiogenesis. Eur J Pharmacol 1999;386:33-40.  https://doi.org/10.1016/S0014-2999(99)00765-7
  27. Yamanaka K, Xu B, Suganuma I, Kusuki I, Mita S, Shimizu Y, et al. Dienogest inhibits aromatase and cyclooxygenase-2 expression and prostaglandin E2 production in human endometriotic stromal cells in spheroid culture. Fertil Steril 2012;97:477-82.  https://doi.org/10.1016/j.fertnstert.2011.11.005
  28. Grandi G, Mueller M, Bersinger NA, Cagnacci A, Volpe A, McKinnon B. Does dienogest influence the inflammatory response of endometriotic cells?: a systematic review. Inflamm Res 2016;65:183-92.  https://doi.org/10.1007/s00011-015-0909-7
  29. Lang J, Yu Q, Zhang S, Li H, Gude K, von Ludwig C, et al. Dienogest for treatment of endometriosis in Chinese women: a placebo-controlled, randomized, double-blind phase 3 study. J Womens Health (Larchmt) 2018;27:148-55.  https://doi.org/10.1089/jwh.2017.6399
  30. Strowitzki T, Faustmann T, Gerlinger C, Seitz C. Dienogest in the treatment of endometriosis-associated pelvic pain: a 12-week, randomized, double-blind, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol 2010;151:193-8.  https://doi.org/10.1016/j.ejogrb.2010.04.002
  31. Seitz C, Gerlinger C, Faustmann T, Strowitzki T. Safety of dienogest in the long-term treatment of endometriosis: a one-year, open label, follow-up study. Fertil Steril 2009;92(3 Suppl):S107. 
  32. Cosson M, Querleu D, Donnez J, Madelenat P, Konincks P, Audebert A, et al. Dienogest is as effective as triptorelin in the treatment of endometriosis after laparoscopic surgery: results of a prospective, multicenter, randomized study. Fertil Steril 2002;77:684-92.  https://doi.org/10.1016/S0015-0282(01)03270-8
  33. Strowitzki T, Marr J, Gerlinger C, Faustmann T, Seitz C. Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod 2010;25:633-41.  https://doi.org/10.1093/humrep/dep469
  34. Ceccaroni M, Clarizia R, Liverani S, Donati A, Ceccarello M, Manzone M, et al. Dienogest vs GnRH agonists as postoperative therapy after laparoscopic eradication of deep infiltrating endometriosis with bowel and parametrial surgery: a randomized controlled trial. Gynecol Endocrinol 2021;37:930-3.  https://doi.org/10.1080/09513590.2021.1929151
  35. Zakhari A, Edwards D, Ryu M, Matelski JJ, Bougie O, Murji A. Dienogest and the risk of endometriosis recurrence following surgery: a systematic review and meta-analysis. J Minim Invasive Gynecol 2020;27:1503-10.  https://doi.org/10.1016/j.jmig.2020.05.007
  36. Liu Y, Gong H, Gou J, Liu X, Li Z. Dienogest as a maintenance treatment for endometriosis following surgery: a systematic review and meta-analysis. Front Med (Lausanne) 2021;8:652505. 
  37. Strowitzki T, Faustmann T, Gerlinger C, Schumacher U, Ahlers C, Seitz C. Safety and tolerability of dienogest in endometriosis: pooled analysis from the European clinical study program. Int J Womens Health 2015;7:393-401.  https://doi.org/10.2147/IJWH.S77202
  38. Lee SR, Yi KW, Song JY, Seo SK, Lee DY, Cho S, et al. Efficacy and safety of long-term use of dienogest in women with ovarian endometrioma. Reprod Sci 2018;25:341-6.  https://doi.org/10.1177/1933719117725820
  39. Osuga Y, Hayashi K, Kanda S. Evaluation of the efficacy, safety, and clinically recommended dose of dienogest in the treatment of primary dysmenorrhea: a randomized, double-blind, multicenter, placebo-controlled study. Fertil Steril 2020;113:167-75.  https://doi.org/10.1016/j.fertnstert.2019.09.014
  40. Techatraisak K, Hestiantoro A, Soon R, Banal-Silao MJ, Kim MR, Seong SJ, et al. Impact of long-term dienogest therapy on quality of life in Asian women with endometriosis: the prospective non-interventional study ENVISIOeN. Reprod Sci 2022;29:1157-69.  https://doi.org/10.1007/s43032-021-00787-w
  41. Momoeda M, Harada T, Terakawa N, Aso T, Fukunaga M, Hagino H, et al. Long-term use of dienogest for the treatment of endometriosis. J Obstet Gynaecol Res 2009;35:1069-76.  https://doi.org/10.1111/j.1447-0756.2009.01076.x
  42. Petraglia F, Hornung D, Seitz C, Faustmann T, Gerlinger C, Luisi S, et al. Reduced pelvic pain in women with endometriosis: efficacy of long-term dienogest treatment. Arch Gynecol Obstet 2012;285:167-73.  https://doi.org/10.1007/s00404-011-1941-7
  43. Heinemann K, Imthurn B, Marions L, Gerlinger C, Becker K, Moehner S, et al. Safety of dienogest and other hormonal treatments for endometriosis in real-world clinical practice (VIPOS): a large noninterventional study. Adv Ther 2020;37:2528-37.  https://doi.org/10.1007/s12325-020-01331-z
  44. Moehner S, Becker K, Lange JA, von Stockum S, Heinemann K. Risk of depression and anemia in users of hormonal endometriosis treatments: results from the VIPOS study. Eur J Obstet Gynecol Reprod Biol 2020;251:212-7.  https://doi.org/10.1016/j.ejogrb.2020.05.049
  45. Klipping C, Duijkers I, Remmers A, Faustmann T, Zurth C, Klein S, et al. Ovulation-inhibiting effects of dienogest in a randomized, dose-controlled pharmacodynamic trial of healthy women. J Clin Pharmacol 2012;52:1704-13.  https://doi.org/10.1177/0091270011423664
  46. Seo JW, Lee DY, Yoon BK, Choi D. Effects of long-term postoperative dienogest use for treatment of endometriosis on bone mineral density. Eur J Obstet Gynecol Reprod Biol 2017;212:9-12.  https://doi.org/10.1016/j.ejogrb.2017.03.011
  47. Kim SE, Lim HH, Lee DY, Choi D. The long-term effect of dienogest on bone mineral density after surgical treatment of endometrioma. Reprod Sci 2021;28:1556-62.  https://doi.org/10.1007/s43032-020-00453-7
  48. Ebert AD, Dong L, Merz M, Kirsch B, Francuski M, Bottcher B, et al. Dienogest 2 mg daily in the treatment of adolescents with clinically suspected endometriosis: the VISanne Study to Assess Safety in ADOlescents. J Pediatr Adolesc Gynecol 2017;30:560-7.  https://doi.org/10.1016/j.jpag.2017.01.014
  49. Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol 2019;15:666-82.  https://doi.org/10.1038/s41574-019-0245-z
  50. National Guideline Alliance (UK). Endometriosis: diagnosis and management. National Institute for Health and Care Excellence (NICE); 2017. 
  51. Park SY, Kim SH, Chae HD, Kim CH, Kang BM. Efficacy and safety of dienogest in patients with endometriosis: a single-center observational study over 12 months. Clin Exp Reprod Med 2016;43:215-20. https://doi.org/10.5653/cerm.2016.43.4.215