FOGSI Consensus Redefines Endometriosis Care with Oral GnRH Antagonist, Elagolix

Elagolix is the first oral, non-peptide GnRH antagonist for management of moderate-to-severe endometriosis associated pain. It competitively blocks pituitary GnRH receptors, causing rapid, dose-dependent suppression of oestrogen without the initial flare effect seen with GnRH agonists.

Elagolix gives option for partial suppression with 150mg OD dosage which maintains estrogen in effective and bone safe range. Elagolix 200mg BID offers complete suppression, ideal for severe dysmenorrhea, non-menstrual pelvic pain (NMPP), dyspareunia and deep infiltrating endometriosis. Systematic review and meta-analysis suggested Elagolix offers greater relief from dysmenorrhoea than other interventions, including injectable GnRH antagonists, Injectable GnRH agonists, progestins and Combined oral contraceptives (COCs), and Elagolix monotherapy provides better improvement in dyspareunia as compared to GnRH analogues with add-back therapy.

The consensus added “Elagolix is generally well tolerated, lower incidence of break-through bleeding with mild, dose-dependent adverse effects such as hot flushes and headache. It has minimal, dose-dependent effects on bone mineral density (BMD), which are typically reversible upon discontinuation of therapy. No new safety signals emerged in long-term studies”.

“Elagolix can be considered as an emerging, potential first-line therapeutic approach in the management of endometriosis” the consensus noted.