Risk factors for non-response and discontinuation of Dienogest in endometriosis patients: A cohort study.

Nirgianakis, Konstantinos; Vaineau, Cloé; Agliati, Lia; McKinnon, Brett; Gasparri, Maria L; Mueller, Michael D. (2021). Risk factors for non-response and discontinuation of Dienogest in endometriosis patients: A cohort study. Acta obstetricia et gynecologica Scandinavica, 100(1), pp. 30-40. Wiley-Blackwell 10.1111/aogs.13969

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INTRODUCTION

Progestins are commonly prescribed first-line drugs for endometriosis. High rates of non-response and intolerance to these drugs have been previously reported. However, no study to date has investigated the characteristics and comorbidities of patients taking progestins in relation to treatment outcomes, so identifying which patients will respond to or tolerate the treatment is currently impossible. The purpose of this study, therefore, was to identify risk factors for non-response and discontinuation of Dienogest (DNG) in women with endometriosis.

MATERIAL AND METHODS

This is a retrospective cohort study including women currently taking, or newly prescribed, DNG for endometriosis-associated pain presenting in the Endometriosis Clinic of the University Hospital of Bern between January 2017 and May 2018. Women with initiation of treatment directly after surgery for endometriosis were excluded. For all participants the symptoms and comorbidities were documented. Effectiveness, tolerability and discontinuation of DNG were the primary end points. Univariate and multivariate binary logistic regression models were carried out to identify risk factors for non-response, intolerance and discontinuation of DNG.

RESULTS

A sufficient or excellent treatment response was reported by 85/125 (68%) participants. Genital bleeding during the DNG treatment was negatively (OR 0.185, 95% CI 0.056-0.610, P = .006) and rASRM endometriosis stages III and IV were positively (OR 3.876, 95% CI 1.202-12.498, P = .023) correlated with the DNG response. When accounting for exclusively pretreatment factors, primary dysmenorrhea (OR 0.236, 95% CI 0.090-0.615, P = .003) and suspicion of adenomyosis (OR 0.347, 95% CI 0.135-0.894, P = .028) were inversely correlated with DNG response, and the latter was also correlated with treatment discontinuation (OR 3.189, 95% CI 1.247-8.153, P = .015).

CONCLUSIONS

Genital bleeding during the DNG treatment and low rASRM stages are independent risk factors for DNG non-response. Before treatment initiation, primary dysmenorrhea and suspicion of adenomyosis correlate with DNG non-response. The results could assist the clinician first to provide detailed information to women before treatment initiation, second to identify and possibly modify in-therapy factors correlated to treatment effectiveness and lastly to switch treatment on time if needed.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Gynaecology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Endometriose und gynäkologische Onkologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Endometriose und gynäkologische Onkologie

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR)

UniBE Contributor:

Nirgianakis, Konstantinos; Vaineau-Bemilli, Cloé Juliette; McKinnon, Brett and Mueller, Michael

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0001-6349

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Monika Zehr

Date Deposited:

12 Jan 2021 16:20

Last Modified:

12 Jan 2021 16:25

Publisher DOI:

10.1111/aogs.13969

PubMed ID:

32767677

Uncontrolled Keywords:

Dienogest endometriosis hormonal treatment medical treatment progestin progestin-only pill response side effects

BORIS DOI:

10.48350/150103

URI:

https://boris.unibe.ch/id/eprint/150103

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