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Ulipristal acetate

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https://www.readbyqxmd.com/read/29139105/preoperative-medical-therapy-before-surgery-for-uterine-fibroids
#1
REVIEW
Anne Lethaby, Lucian Puscasiu, Beverley Vollenhoven
BACKGROUND: Uterine fibroids occur in up to 40% of women aged over 35 years. Some are asymptomatic, but up to 50% cause symptoms that warrant therapy. Symptoms include anaemia caused by heavy menstrual bleeding, pelvic pain, dysmenorrhoea, infertility and low quality of life. Surgery is the first choice of treatment. In recent years, medical therapies have been used before surgery to improve intraoperative and postoperative outcomes. However, such therapies tend to be expensive.Fibroid growth is stimulated by oestrogen...
November 15, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29138584/repeated-intermittent-ulipristal-acetate-in-the-treatment-of-uterine-fibroids-a-cost-effectiveness-analysis
#2
Kirk Geale, Ertan Saridogan, Matthieu Lehmann, Pablo Arriagada, Marcus Hultberg, Martin Henriksson
There are limited treatment options available for women with moderate to severe symptoms of uterine fibroids (UFs) who wish to avoid surgery. For these women, treatment with standard pharmaceuticals such as contraceptives is often insufficient to relieve symptoms, and patients may require surgery despite their wish to avoid it. Clinical trials demonstrate that ulipristal acetate 5 mg (UPA) is an effective treatment for this patient group, but its cost-effectiveness has not been assessed in this population. A decision-analytic model was developed to simulate a cohort of patients in this population under treatment with UPA followed by surgery as needed compared to treatment with iron and non-steroidal anti-inflammatory drug (NSAID) followed by surgery as needed (best supportive care, BSC)...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/29121217/effect-of-ulipristal-acetate-and-mifepristone-at-emergency-contraception-dose-on-the-embryo-endometrial-attachment-using-an-in-vitro-human-trophoblastic-spheroid-and-endometrial-cell-co-culture-model
#3
Hang-Wun Raymond Li, Ying-Xing Li, Tian-Tian Li, Hongjie Fan, Ernest Hung-Yu Ng, William Shu-Biu Yeung, Pak-Chung Ho, Kai-Fai Lee
STUDY QUESTION: Do both ulipristal acetate (UPA) and mifepristone inhibit embryo-endometrial attachment at concentrations corresponding to the emergency contraception (EC) dose? SUMMARY ANSWER: Both UPA and mifepristone at concentrations corresponding to the EC dose do not have an inhibitory effect on embryo implantation, although mifepristone at a higher concentration appeared to have such an effect. WHAT IS KNOWN ALREADY: Levonorgestrel is commonly used for EC, but it only acts through inhibition of ovulation...
November 7, 2017: Human Reproduction
https://www.readbyqxmd.com/read/29108079/prevalence-and-correlates-of-emergency-contraceptive-use-in-transitional-albania
#4
Dajana Roshi, Salvatore Italia, Genc Burazeri, Helmut Brand
Objectives The two emergency contraceptive drugs ("morning-after pill") ulipristal acetate and levonorgestrel are available without prescription in many European countries. In Albania, ulipristal acetate is not marketed yet and levonorgestrel has still prescription-only status. The objective of this study was to assess the prevalence and socioeconomic correlates of emergency contraceptive (EMC) use, collect sales figures, and gain information on the women's way of purchasing EMCs in post-communist Albania. Methods For this cross-sectional study, self-administered questionnaires were made accessible to women in Albania in March 2015 by hard copy or online via social networks...
November 6, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/29105584/is-ulipristal-acetate-the-new-drug-of-choice-for-the-medical-management-of-uterine-fibroids-res-ipsa-loquitur
#5
Funlayo Odejinmi, Reeba Oliver, Rebecca Mallick
Ulipristal acetate (Esmya(©)) has been hailed the new wonder drug with regard to the medical management of uterine fibroids, and many postulate that it will remove the need for surgical treatment in the future. While the results from the PEARL studies are certainly promising and its amenorrhoeic rates and reduction in fibroid size are unquestionable, there is still a paucity of data with regard to its long-term effects, the effects on its usage prior to surgery and its variable efficacy in different ethnic populations...
November 1, 2017: Women's Health
https://www.readbyqxmd.com/read/29102184/determination-of-progestogens-in-surface-and-waste-water-using-spe-extraction-and-lc-apci-appi-hrps
#6
Oksana Golovko, Pavel Šauer, Ganna Fedorova, Hana Kocour Kroupová, Roman Grabic
The aim of this study was to develop a reliable analytical method for the measurement of 17 selected progestogens in waste water and surface water. Automated whole water solid phase extraction (SPE) was used for sample concentration. Liquid chromatography tandem atmospheric pressure chemical ionization/atmospheric pressure photoionization with hybrid quadrupole/orbital trap mass spectrometry operated in high resolution product scan mode (LC-APCI/APPI-HRPS) was applied for the analyses. The whole-method recoveries ranged from 60% to 140% for all analytes at two different spike levels (5 and 50ng/L) in the studied matrices...
October 25, 2017: Science of the Total Environment
https://www.readbyqxmd.com/read/29097224/pharmacy-access-to-ulipristal-acetate-in-major-cities-throughout-the-united-states
#7
Maryssa Shigesato, Jennifer Elia, Mary Tschann, Holly Bullock, Eric Hurwitz, Yan Yan Wu, Jennifer Salcedo
OBJECTIVE: Ulipristal acetate (UPA) is a prescription emergency contraceptive pill (ECP). Despite the potential for UPA to reduce the risk of unintended pregnancies, a recent study in Hawaii demonstrated less than 3% of pharmacies stocked UPA and less than 23% reported the ability to order it. The primary outcome of our study was to assess the availability of UPA in a sample of large cities nationwide. STUDY DESIGN: We conducted a telephone-based secret shopper study of 533 retail pharmacies sampled proportionally from ten large cities in five geographic regions across the US...
October 30, 2017: Contraception
https://www.readbyqxmd.com/read/29079463/a-multicenter-study-evaluating-the-effect-of-ulipristal-acetate-during-myomectomy
#8
Ally Murji, Marta Wais, Sabrina Lee, Alice Pham, Melissa Tai, Grace Liu
STUDY OBJECTIVE: To compare surgical experience at myomectomy between patients with fibroids pretreated with ulipristal acetate versus no pretreatment. DESIGN: Prospective, observational, multicenter study of myomectomy procedures by any route (hysteroscopic, laparoscopic or laparotomy). DESIGN CLASSIFICATION: Canadian Task Force Classification II-2. SETTING: Five university-affiliated hospitals including tertiary care and community sites...
October 24, 2017: Journal of Minimally Invasive Gynecology
https://www.readbyqxmd.com/read/29036770/emergency-contraception-oral-and-intrauterine-options
#9
Kirsten I Black, Safeera Y Hussainy
BACKGROUND: Emergency contraception can be used to prevent pregnancy where contraception has not been used, or there has been contraceptive misuse or failure. Australian women have three options for emergency contraception: two types of oral pills (levonorgestrel [LNG]-containing pill and ulipristal acetate [UPA]) and the copper intrauterine device (IUD). Both pills are available from pharmacies without prescription, whereas the copper IUD requires insertion by a trained provider. OBJECTIVE: The objective of this article is to describe the indications, efficacy and contraindications for use of the three emergency contraceptive methods available in Australia...
October 2017: Australian Family Physician
https://www.readbyqxmd.com/read/29036173/pre-treatment-with-gnrha-or-ulipristal-acetate-prior-to-laparoscopic-and-laparotomic-myomectomy-a-systematic-review-and-meta-analysis
#10
REVIEW
Inge de Milliano, Moniek Twisk, Johannes C Ket, Judith A Huirne, Wouter J Hehenkamp
BACKGROUND: Myomectomy has potential risks of complications. To reduce these risks, medical pre-treatment can be applied to reduce fibroid size and thereby potentially decrease intra-operative blood loss, the need for blood transfusion and emergency hysterectomy. The aim of this systematic review and meta-analysis is to study the effectiveness of medical pre-treatment with Gonadotropin-releasing hormone agonists (GnRHa) or ulipristal acetate prior to laparoscopic or laparotomic myomectomy on intra-operative and post-operative outcomes...
2017: PloS One
https://www.readbyqxmd.com/read/29025038/selective-progesterone-receptor-modulators-for-fertility-preservation-in-women-with-symptomatic-uterine-fibroids
#11
Mohamed Ali, Ayman Al-Hendy
Uterine fibroids (UFs, AKA leiomyoma) are the most important benign neoplastic threat to women's health, with costs up to hundreds of billions of health care dollars worldwide. Uterine fibroids caused morbidities exert a tremendous health toll, impacting the quality of life of women of all ethnicities, especially women of color. Clinical presentations include heavy vaginal bleeding, pelvic pain, bulk symptoms, subfertility, and obstetric complications. Current management strategies heavily lean toward surgical procedures; nonetheless, the choice of treatment is generally subject to patient's age and her desire to preserve future fertility...
September 1, 2017: Biology of Reproduction
https://www.readbyqxmd.com/read/28933575/unexpected-uterine-leiomyosarcoma-in-a-woman-with-multiple-myomas-treated-with-ulipristal-acetate-case-report-and-literature-review
#12
Paola Modaffari, Marta D'alonzo, Marta Garbagnati, Silvia Pecchio, Guido Menato, Nicoletta Biglia
Ulipristal acetate (UPA) has been recognized as an alternative strategy to surgery in the management of symptomatic women with uterine fibroids. We present a case report on a woman with hereditary fibrinogen deficiency exclusively treated with UPA for myoma-related menorrhagia and abdominal pain, who subsequently underwent a hysterectomy because of clinical worsening. A FIGO IB uterine leiomyosarcoma was found among multiple myomas. A review of the literature found two other cases of uterine leiomyosarcoma in patients treated with UPA: clinical data are reported...
September 21, 2017: Gynecological Endocrinology
https://www.readbyqxmd.com/read/28929861/ulipristal-acetate-and-extracellular-matrix-production-in-human-leiomyomas-in-vivo-a-laboratory-analysis-of-a-randomized-placebo-controlled-trial
#13
Jeris Cox, Minnie Malik, Joy Britten, Terrence Lewis, William H Catherino
In a prior randomized controlled study, patients treated with ulipristal acetate (UPA) or placebo for 3 months had a decrease in leiomyoma size. A total of 10 patients' tissue samples (5 placebo and 5 treated with 10 mg/d UPA) that underwent hysterectomy and tissue preservation were identified from this study. Quantitative real-time reverse transcriptase polymerase chain reaction and Western blotting were used to assess fold gene and protein expression of extracellular membrane (ECM) proteins: collagen 1A (COL1A), fibronectin (FN1), and versican (VCAN) of the samples...
January 1, 2017: Reproductive Sciences
https://www.readbyqxmd.com/read/28919823/updated-approaches-for-management-of-uterine-fibroids
#14
REVIEW
Aymara Mas, Marta Tarazona, Joana Dasí Carrasco, Gloria Estaca, Ignacio Cristóbal, Javier Monleón
Uterine anatomy and uterine fibroids (UFs) characteristics have been classically considered as almost a unique issue in gynecology and reproductive medicine. Nowadays, the management of UF pathology is undergoing an important evolution, with the patient's quality of life being the most important aspect to consider. Accordingly, surgical techniques and aggressive treatments are reserved for only those cases with heavy symptomatology, while the clinical diagnostic based on size and number of UFs remains in a second plane in these situations...
2017: International Journal of Women's Health
https://www.readbyqxmd.com/read/28919793/burden-of-uterine-fibroids-in-italy-epidemiology-treatment-outcomes-and-consumption-of-health-care-resources-in-more-than-5-000-women
#15
Marco Chiumente, Mauro De Rosa, Andrea Messori, Enrica Maria Proli
BACKGROUND AND PURPOSE: Epidemiological studies on uterine fibroids (UFs) are mostly based on surveys or analyses of small samples of patients. In 50% of women, the quality of life is worsened by disease-related symptoms; furthermore, treatments imply a remarkable health care cost. The aim of this observational study was to analyze a large sample of Italian patients with UFs and to assess the epidemiology, the appropriateness of treatments, and the consumption of disease-related resources...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/28914672/endometrial-changes-in-surgical-specimens-of-perimenopausal-patients-treated-with-ulipristal-acetate-for-uterine-leiomyomas
#16
Francisco F Nogales, Vicente Crespo-Lora, Nelly Cruz-Viruel, Clara Chamorro-Santos, Christine Bergeron
Ulipristal acetate (UPA) is used to treat leiomyomas, and its effect on the endometrium has been studied in biopsy material. Reversible histologic modifications were found, named progesterone receptor modulators-associated endometrial changes (PAEC). However, hysterectomies from patients treated with UPA have not been analyzed. For the first time, we examined surgical specimens from 100 leiomyoma-treated patients for UPA-related endometrial changes. We analyzed the distribution of lesions, involution after treatment, and the relationship between type and extent of lesions and dosage...
September 13, 2017: International Journal of Gynecological Pathology
https://www.readbyqxmd.com/read/28900897/ulipristal-acetate-a-review-in-symptomatic-uterine-fibroids
#17
Karly P Garnock-Jones, Sean T Duggan
Oral ulipristal acetate (Esmya(®); Fibristal(®)), a synthetic selective progesterone receptor modulator, is the first selective progesterone modulator to be approved for the treatment of uterine fibroids. It was initially approved for the preoperative treatment of moderate to severe uterine fibroid symptoms in women of reproductive age. Recently, the indication was extended in the EU to include the intermittent treatment of moderate to severe uterine fibroid symptoms. This narrative review summarizes pharmacological, efficacy and tolerability data relevant to the preoperative and intermittent use of ulipristal acetate in patients with symptomatic uterine fibroids...
October 2017: Drugs
https://www.readbyqxmd.com/read/28871011/economic-impact-of-ulipristal-acetate-on-surgical-procedures-for-uterine-fibroids-in-france
#18
Hervé Fernandez, Olivier Jourdain, Vincent Villefranque, Matthieu Lehmann, Antoine Lafuma, Matthieu Trancart
OBJECTIVE: To assess the budget impact of using ulipristal acetate (UPA) 5 mg to treat women with uterine fibroids (UF) causing moderate to severe symptoms. DESIGN: We modelled trends in the number of surgical procedures for symptomatic UF, with and without the use of UPA for preoperative or intermittent treatment and assessed the budget impact of UPA use from the French national healthcare insurance system perspective. SETTING: A French national hospital database (PMSI) that records admissions and relative procedures to public and private hospitals...
September 3, 2017: BMJ Open
https://www.readbyqxmd.com/read/28854585/sperm-chemorepulsion-a-supplementary-mechanism-to-regulate-fertilization
#19
H A Guidobaldi, M Cubilla, A Moreno, M V Molino, L Bahamondes, L C Giojalas
STUDY QUESTION: Are human spermatozoa able of chemorepulsive behaviour? SUMMARY ANSWER: Capacitated human spermatozoa are able to be chemorepelled by synthetic Progesterone Receptor Ligands (sPRL, known as contraceptives) and zinc (a cation released by the oocyte upon fertilization). WHAT IS KNOWN ALREADY: Moving cells can be oriented towards or against a molecular gradient, processes called chemoattraction and chemorepulsion, respectively, which have been described in unicellular organisms such as amoebas and bacteria, to organismic cells such macrophages and developmental cells...
August 1, 2017: Human Reproduction
https://www.readbyqxmd.com/read/28780215/knowledge-of-and-interest-in-the-copper-intrauterine-device-among-women-seeking-emergency-contraception
#20
Christine Edwards, Dilzayn Panjwani, Ciara Pendrith, Anna Ly, Sheila Dunn
OBJECTIVE: Emergency contraception (EC) includes hormonal pills (levonorgestrel or ulipristal acetate) and the copper IUD (Cu-IUD). The Cu-IUD is more effective for EC than hormonal pills but remains underused, possibly because of lack of knowledge or interest. The objective of this study was to examine knowledge of and interest in the Cu-IUD for EC among Canadian women seeking EC. METHODS: The study used a cross-sectional convenience survey of English-speaking women presenting for EC at two sexual health clinics in Toronto...
August 2, 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
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