THE EVALUATION OF EFFICACY AND SAFETY OF APPLICATION OF ULIPRISTAL ACETATE IN THE TREATMENT OF PATIENTS WITH VARIOUS TYPES OF UTERINE FIBROIDS

Objectives: Despite a fairly large clinical experience in treatment of uterine fibroids, effect of treatment is often incomplete, disease progresses, which requires radical surgical intervention. In this regard, search for the most accessible and highly effective methods of therapy is of great practical importance.

Aims: The aim of the study was to assess efficiency and safety of treatment based on ulipristal acetate in patients of reproductive age diagnosed with simple or proliferating uterine fibroids.

Material and methods: A prospective randomized study of efficiency of ulipristal acetate in 150 patients with simple (group I) and proliferating (group II) uterine fibroids was conducted in the Department of Gynaecology at I.M.Sechenov Medical University. Histological and immunohistochemical study of uterine leiomyomas were performed by the Pathology Department.

Results: After 3 months of treatment, amenorrhea was observed in 70% and 90% of patients in both groups I and II, respectively. After 3 months, reduction of nodes diameter by 27% in group I and by 47% in group II was revealed. In 80% of patients in both groups, average decrease of endometrium to 4-5 mm was found, in 10% - thickness of the endometrium reached 8 mm and 10% of patients were found to increase thickness of endometrium to 12 - 14 mm. Ulipristal reduces the leiomyomas size not only due to tumor cell apoptosis induction, and reduction of their proliferative and mitotic activity, but also due to angiogenesis and growth factors inhibition in combination with increased level of matrix metalloproteinases production and their tissue inhibitors.

Conclusion: Ulipristal causes simultaneous negative impact on parenchymal components, angiogenesis and extracellular matrix and leads to rapid, significant and sustained decrease in leiomyomas volume. The obtained data allow us to recommend the application of ulipristal acetate as preoperative preparation in the group of patients with simple and proliferating uterine fibroids.