[New medical treatments for painful endometriosis: CNGOF-HAS Endometriosis Guidelines]

Abstract

Objective: The objective of this work is to evaluate the place of new treatments in the management of endometriosis outside the context of infertility.

Methods: A review of the literature was conducted by consulting Medline data until July 2017.

Results: Dienogest is effective compared to placebo in short term (NP2) and long term (NP4) for the treatment of painful endometriosis. In comparison with GnRH agonists, dienogest is also effective in terms of decreased pain and improved quality of life in non-operated patients (NP2) as well as for recurrence of lesions and symptomatology postoperatively (NP2). Data on GnRH antagonists, selective progesterone receptor modulators as well as selective inhibitors (anti-TNF-α, matrix metalloprotease inhibitors, angiogenesis growth factor inhibitors) are insufficient to provide evidence of interest in clinical practice for the management of painful endometriosis (NP3).

Conclusion: Dienogest is recommended as second-line therapy for the management of painful endometriosis (Grade B). Because of lack of evidence, aromatase inhibitors, elagolix, SERM, SPRM and anti-TNF-α are not recommended for the management of painful endometriosis (Grade C).

Keywords: Agonistes de la GnRH; Anti-TNF alpha; Anti-angiogenic treatment; Anti-angiogéniques; Aromatase inhibitors; Cox 2 inhibitors; Dienogest; Diénogest; Endometriosis; Endométriose; GnRH agonists; Inhibiteurs de la Cox 2; Inhibiteurs de l’aromatase; Inhibiteurs des métalloprotéases matricielles; Matrix metalloproteinase inhibitors; Medical treatment; Mifepristone; Modulateurs des récepteurs sélectifs de la progestérone; Modulateurs des récepteurs sélectifs de l’estrogène; Selective estrogen receptor modulators; Selective progesterone receptor modulators; Traitement médical.