Manajemen Jangka Panjang Endometriosis: Dapatkah Progestin Menjadi Andalan?

Hartanto Bayuaji


Abstract


Latar belakang: pada tahun 2014 The Practice Committee of The American Society of Reproductive Medicine menyebutkan bahwa endometriosis merupakan penyakit kronis yang memerlukan penanganan jangka panjang dengan titik berat pada terapi medikamentosa. Progestin merupakan modalitas terapi yang berpotensi digunakan dalam jangka panjang. Dienogest merupakan progestin turunan 19-nortestosteron dengan pengaruh pada endometrium dan antiinflamasi yang kuat merupakan pilihan untuk terapi jangka panjang endometriosis.
Metode: telaah pustaka.
Hasil: dalam manajemen endometriosis, progestin digunakan dalam terapi jangka panjang serta untuk mencegah rekurensi. Penggunaan dienogest jangka panjang menurunkan skor visual analogue scale secara bermakna dari beberapa penelitian. Analisis efektivitas-biaya menunjukkan profil penghematan biaya yang lebih baik pada dienogest dibandingkan goserelin. Rekurensi endometriosis pasca operasi menurun secara bermakna pada wanita yang mendapat terapi dienogest. Dalam suatu network meta-analysis diketahui bahwa kombinasi agonis GnRH + dienogest diharapkan menjadi pilihan terbaik pencegahan rekurensi. Dari dua penelitian dengan subjek wanita Asia, efek samping dienogest terjadi pada sekitar 13,27% - 31,5% subjek dan umumnya bersifat ringan. Perubahan pola perdarahan uterus merupakan hal yang sering disampaikan subjek. Kepadatan mineral tulang mengalami penurunan pada pemberian dienogest namun mengingat pentingnya pencegahan rekurensi dan menghindari operasi ulang, keputusan penggunaan dienogest sebaiknya tidak hanya didasarkan pada hal ini saja.
Simpulan: data menunjukkan bahwa dalam konsep terapi jangka panjang, progestin merupakan modalitas yang amat penting. Dienogest merupakan salah satu pilihan untuk manajemen jangka panjang endometriosis. Pengawasan penggunaan progestin harus selalu diperhatikan untuk mengupayakan diperolehnya hasil yang optimal.

The Long Term Management Of Endometriosis: are Progestins the Reliable Choice?

Abstract
Background: in 2014, The Practice Committee of The American Society of Reproductive Medicine stated that endometriosis should be viewed as a chronic disease that requires a lifelong management, with focus on progestins. Dienogest, a 19-nortestosterone derivative, is a progestin compound with strong endometrium effects and antiinflammatory property that may become an option in long term management of endometriosis.
Method: literature review
Results: progestins might be applied in both long term management and prevention of recurrence of endometriosis. The significant reduction of visual analogue scale score were found in several study. The cost-effectiveness analysis reveals better cost-saving profile of dienogest when compared with goserelin. Women who received postoperative dienogest treatment have reduced incidence of recurrence. In one network meta-analysis study, the GnRH agonist + dienogest combination revealed the best option for preventing recurrence. The adverse effects of dienogest from 2 Asian studies range from 13.27% - 31.5%, mostly mild cases. Changes in uterine bleeding pattern were the most common reported side effects. The bone mineral density decreased after dienogest treatment, however, considering the benefit of dienogest for preventing recurrence and repeated operation, the use of dienogest should not be solely based on bone mineral density changes.
Conclusion: progestin is the important mainstay of long term therapi in endometriosis. Dienogest is an option in long term management of endometriosis. However, monitoring of their usage should be an important aspects to ensure optimal outcomes are achieved.

Key words: bleeding pattern, bone mineral density, dienogest, endometriosis, long term management, progestins.


Keywords


dienogest, endometriosis, kepadatan mineral tulang, manajemen jangka panjang, pola perdarahan, progestin.

Full Text:

PDF

References


Practice Committee of the American Society for Reproductive M. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril. 2014;101(4):927-35.

Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009.

Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021;397(10276):839-52.

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(3):537-48.

Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666-82.

Koga K, Takamura M, Fujii T, Osuga Y. Prevention of the recurrence of symptom and lesions after conservative surgery for endometriosis. Fertil Steril. 2015;104(4):793-801.

Ruan X, Seeger H, Mueck AO. The pharmacology of dienogest. Maturitas. 2012;71(4):337-44.

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(3):183-92.

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(3):633-41.

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(1):167-73.

Techatraisak K, Hestiantoro A, Ruey S, Banal-Silao MJ, Kim MR, Seong SJ, et al. Effectiveness of dienogest in improving quality of life in Asian women with endometriosis (ENVISIOeN): interim results from a prospective cohort study under real-life clinical practice. BMC Womens Health. 2019;19(1):68.

Romer T. Long-term treatment of endometriosis with dienogest: retrospective analysis of efficacy and safety in clinical practice. Arch Gynecol Obstet. 2018;298(4):747-53.

Dai Y, Shi B, Huang X, Duan J, Qiu Y, Ha C, et al. Cost-effectiveness Analysis of Dienogest Compared With Gonadotropin-Releasing Hormone Agonist After Conservative Surgery for Endometriosis in China. Clin Ther. 2021;43(8):1276-84 e1.

Guo SW. Recurrence of endometriosis and its control. Hum Reprod Update. 2009;15(4):441-61.

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(7):1503-10.

Chiu CC, Hsu TF, Jiang LY, Chan IS, Shih YC, Chang YH, et al. Maintenance Therapy for Preventing Endometrioma Recurrence after Endometriosis Resection Surgery - A Systematic Review and Network Meta-analysis. J Minim Invasive Gynecol. 2022;29(5):602-12.

Moehner S, Becker K, Lange JA, Stockum SV, Serrani M, Heinemann K. Long-term treatment of endometriosis with dienogest: real-world results from the VIPOS study. J Endometriosis Pelvic Pain. 2021:1-7.

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.

Cho B, Roh JW, Park J, Jeong K, Kim TH, Kim YS, et al. Safety and Effectiveness of Dienogest (Visanne(R)) for Treatment of Endometriosis: A Large Prospective Cohort Study. Reprod Sci. 2020;27(3):905-15.

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(5):1556-62.

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.




DOI: http://dx.doi.org/10.24198/obgynia.v6i2.527

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.


     
     

Creative Commons License
Indonesian Journal of Obstetrics & Gynecology Science is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License
  Web Analytics
  View My Stat