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Ulipristal Acetate Esmya ® versus Placebo
for Fibroid Treatment before Surgery

N Engl J Med 2012; 366:409-420February 2, 2012
Jacques Donnez, M.D., Ph.D., Tetyana F. Tatarchuk, M.D., Ph.D., Philippe Bouchard, M.D., Lucian Puscasiu, M.D., Ph.D., Nataliya F. Zakharenko, M.D., Ph.D., Tatiana Ivanova, M.D., Ph.D., Gyula Ugocsai, M.D., Ph.D., Michal Mara, M.D., Ph.D., Manju P. Jilla, M.B., B.S., M.D., Elke Bestel, M.D., Paul Terrill, Ph.D., Ian Osterloh, M.R.C.P., and Ernest Loumaye, M.D., Ph.D. for the PEARL I Study Group

l'ulipristal acetate - Esmya ® dans le traitement des fibromes utérins.
Le saignement utérin fut contrôlé chez 90% des patientes recevant 5 mg d'ulipristal acetate, chez 98% de celles qui en ont reçu 10 mg, et chez 89% des patientes qui avaient reçu de l'acetate leuprolide. Le contrôle du saignement utérin (arrêt des hémorragies) est significativement plus précoce chez les patientes traitées par UA (ulipristal acetate).
Une autre étude versus injections intramusculaires d'acétate de leuprolide une fois par mois a montré une efficacité comparable. (Ulipristal Acetate versus Leuprolide Acetate for Uterine Fibroids [Lire]). Le contrôle du saignement utérin est significativement plus précoce chez les patientes traitées par UA (ulipristal acetate). : 5 à 7 jours / 21 jours
L'ulipristal acétate est un analogue structural de la progestérone, proche au niveau de sa formule chimique, du RU486 et utilisé dans EllaOne


BACKGROUND
The efficacy and safety of oral ulipristal acetate for the treatment of symptomatic uterine fibroids before surgery are uncertain.

METHODS
We randomly assigned women with symptomatic fibroids, excessive uterine bleeding (a score of >100 on the pictorial blood-loss assessment chart [PBAC, an objective assessment of blood loss, in which monthly scores range from 0 to >500, with higher numbers indicating more bleeding]) and anemia (hemoglobin level of =10.2 g per deciliter) to receive treatment for up to 13 weeks with oral ulipristal acetate at a dose of 5 mg per day (96 women) or 10 mg per day (98 women) or to receive placebo (48 women). All patients received iron supplementation. The coprimary efficacy end points were control of uterine bleeding (PBAC score of <75) and reduction of fibroid volume at week 13, after which patients could undergo surgery.

RESULTS
At 13 weeks, uterine bleeding was controlled in 91% of the women receiving 5 mg of ulipristal acetate, 92% of those receiving 10 mg of ulipristal acetate, and 19% of those receiving placebo (P<0.001 for the comparison of each dose of ulipristal acetate with placebo). The rates of amenorrhea were 73%, 82%, and 6%, respectively, with amenorrhea occurring within 10 days in the majority of patients receiving ulipristal acetate. The median changes in total fibroid volume were -21%, -12%, and +3% (P=0.002 for the comparison of 5 mg of ulipristal acetate with placebo, and P=0.006 for the comparison of 10 mg of ulipristal acetate with placebo). Ulipristal acetate induced benign histologic endometrial changes that had resolved by 6 months after the end of therapy. Serious adverse events occurred in one patient during treatment with 10 mg of ulipristal acetate (uterine hemorrhage) and in one patient during receipt of placebo (fibroid protruding through the cervix). Headache and breast tenderness were the most common adverse events associated with ulipristal acetate but did not occur significantly more frequently than with placebo.

CONCLUSIONS
Treatment with ulipristal acetate for 13 weeks effectively controlled excessive bleeding due to uterine fibroids and reduced the size of the fibroids.

(Funded by PregLem; ClinicalTrials.gov number, NCT00755755.)
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