Efficacy of ulipristal acetate in women with fibroid induced menorrhagia: A systematic review and meta-analysis

Abstract

Aim: To evaluate the efficacy of UPA in women with fibroid induced menorrhagia.

Methods: Embase, MEDLINE, CAB Abstracts, Cochrane Central Register of Controlled Trials, PsychInfo were searched up to 18th May 2020 and updated on 7th February 2021. Randomised controlled trials evaluating the efficacy of UPA in women with fibroid induced menorrhagia were included in the study.

Results: Two authors independently reviewed and extracted the study data. Statistical heterogeneity was quantified using I² statistics. Publication bias and data asymmetry was assessed by funnel plots. A meta-analysis was conducted where appropriate. Six studies were eligible for inclusion. UPA (5 mg and 10 mg) achieved statistically significant amenorrhoeic outcome when compared to placebo (p<0.00001). Increased adverse events (AE) profile was observed in the higher UPA dose, however, did not reach statistical significance.

Conclusions: This review demonstrates the efficacy of UPA in achieving amenorrhoea in women with fibroid induced menorrhagia. However, the favourable dose of UPA remains inconclusive when AE profile is taken into account. Evidence remains obscure regarding liver damage and further research is warranted to attain a conclusive outcome.

Keywords: Adverse effects; Amenorrhoea; Fibroids; Liver injury; Quality of life; Ulipristal acetate.