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[PMID]:29236373
[Au] Autor:Couillard K
[Ti] Título:Fibromes utérins. L'ulipristal approuvé pour une utilisation prolongée..
[So] Source:Perspect Infirm;14(2):57, 2017 Mar-Apr.
[Is] ISSN:1708-1890
[Cp] País de publicação:Canada
[La] Idioma:fre
[Mh] Termos MeSH primário: Leiomioma/tratamento farmacológico
Norpregnadienos/uso terapêutico
Neoplasias Uterinas/tratamento farmacológico
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Norpregnadienos/administração & dosagem
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Norpregnadienes); YF7V70N02B (ulipristal acetate)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:29199806
[Au] Autor:Sarvilinna N; Unkila-Kallio; Härkki P; Tiitinen A; Heikinheimo O
[Ti] Título:Selective progesterone receptor modulators: new possibilities for gynecologic hormone therapy.
[So] Source:Duodecim;133(1):27-33, 2017.
[Is] ISSN:0012-7183
[Cp] País de publicação:Finland
[La] Idioma:eng
[Ab] Resumo:Progesterone regulates several female reproductive functions. Progesterone and synthetic progestins derived from it have long been utilized in gynecology. The effects of these steroids in target cells are mediated via progesterone receptors, Progesterone receptors are also the target of action of selective progesterone receptor modulators. Of the molecules of this newer group of drugs, two are presently in clinical use. Mifepristone is used in nonsurgical abortion, in softening of the cervix before surgical abortion, and in the induction of labor in cases of intrauterine death. The indications of ulipristal acetate are postcoital contraception and treatment of uterine myomas and the resulting symptoms.
[Mh] Termos MeSH primário: Antagonistas de Hormônios/uso terapêutico
Mifepristona/uso terapêutico
Norpregnadienos/uso terapêutico
Receptores de Progesterona/efeitos dos fármacos
Saúde Reprodutiva
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Saúde da Mulher
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Hormone Antagonists); 0 (Norpregnadienes); 0 (Receptors, Progesterone); 320T6RNW1F (Mifepristone); 6J5J15Q2X8 (ulipristal)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE


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[PMID]:29250979
[Au] Autor:Ferrero S; Vellone VG; Barra F
[Ad] Endereço:a Academic Unit of Obstetrics and Gynecology , Ospedale Policlinico San Martino , Genoa , Italy.
[Ti] Título:Pharmacokinetic drug evaluation of ulipristal acetate for the treatment of uterine fibroids.
[So] Source:Expert Opin Drug Metab Toxicol;14(1):107-116, 2018 Jan.
[Is] ISSN:1744-7607
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Uterine fibroids are the most common form of benign gynecological tumors in women of reproductive ages. Although surgery is the main option to treat them, alternative pharmacological approaches are being investigated to control their symptoms. Among them, ulipristal acetate (UPA) has been the first selective progesterone-receptor modulator (SPRM) approved for the pre-operative and long-term treatment of uterine fibroids. Areas covered: The aim of this article is to review the literature on the pharmacodynamics, pharmacokinetics (PK), clinical efficacy and safety of UPA for the treatment of uterine fibroids. Expert opinion: UPA has both agonistic and antagonistic activity on progesterone receptor. Results from PK studies have shown that it has good oral bioavailability, and that it is extensively metabolized in the liver by cytochrome (CYP) 3A4. The PEARL I-II showed that the preoperative treatment with UPA decreases uterine bleeding, uterine volume and fibroid size in women with symptomatic uterine leiomyomas. The PEARL III and IV trials demonstrated the efficacy and safety of long-term intermittent treatment with UPA for the control of fibroid-related symptoms.
[Mh] Termos MeSH primário: Leiomioma/tratamento farmacológico
Norpregnadienos/administração & dosagem
Neoplasias Uterinas/tratamento farmacológico
[Mh] Termos MeSH secundário: Administração Oral
Animais
Disponibilidade Biológica
Feminino
Seres Humanos
Leiomioma/patologia
Norpregnadienos/farmacocinética
Norpregnadienos/farmacologia
Receptores de Progesterona/efeitos dos fármacos
Receptores de Progesterona/metabolismo
Fatores de Tempo
Neoplasias Uterinas/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Norpregnadienes); 0 (Receptors, Progesterone); YF7V70N02B (ulipristal acetate)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180101
[Lr] Data última revisão:
180101
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.1080/17425255.2018.1417389


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[PMID]:29036173
[Au] Autor:de Milliano I; Twisk M; Ket JC; Huirne JA; Hehenkamp WJ
[Ad] Endereço:Department of Obstetrics and Gynecology, VU Medical Center, Amsterdam, The Netherlands.
[Ti] Título:Pre-treatment with GnRHa or ulipristal acetate prior to laparoscopic and laparotomic myomectomy: A systematic review and meta-analysis.
[So] Source:PLoS One;12(10):e0186158, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Myomectomy has potential risks of complications. To reduce these risks, medical pre-treatment can be applied to reduce fibroid size and thereby potentially decrease intra-operative blood loss, the need for blood transfusion and emergency hysterectomy. The aim of this systematic review and meta-analysis is to study the effectiveness of medical pre-treatment with Gonadotropin-releasing hormone agonists (GnRHa) or ulipristal acetate prior to laparoscopic or laparotomic myomectomy on intra-operative and post-operative outcomes. METHODS: We performed an extensive search in Embase.com, Wiley/Cochrane Library and PubMed in accordance with the Prisma guidelines. All studies published as full papers in peer reviewed journals using GnRHa or ulipristal acetate as medical pre-treatment independent of route of administration or dosage before laparotomic or laparoscopic myomectomy were included. The primary outcome was duration of surgery. Secondary outcomes were duration of enucleation, blood loss, degree of difficulty of surgery, identification of cleavage planes, proportion of vertical incisions, conversion rate, frequency of blood transfusions, post-operative complications, duration of hospital stay, frequency of recurrence of fibroids, frequency of uterine adhesions, recovery time and quality of life. No language restrictions were applied. Meta-analysis were performed where possible. FINDINGS: Twenty-three studies were included. In laparotomic myomectomy, pre-treatment with GnRHa decreases intra-operative blood loss with 97.39ml (95% CI -111.80 to -82.97) compared to no pre-treatment or placebo. Pre-treatment with GnRHa before laparoscopic myomectomies also shows a reduction in intra-operative blood loss by 23.03ml (95% CI -40.79 to -5.27) and in the frequency of blood transfusions (OR 0.17, 95% CI 0.05 to 0.55) compared to no pre-treatment. Only two retrospective cohort studies reported on pre-treatment with ulipristal acetate compared to no pre-treatment before laparoscopic myomectomy showing a statistically significant reduction in intra-operative blood loss, duration of surgery and frequency of blood transfusions after pre-treatment with ulipristal acetate. CONCLUSION: Administration of GnRHa prior to laparotomic myomectomy reduces blood loss and might decrease uterine adhesion formation. Pre-treatment with GnRHa before laparoscopic myomectomy reduces blood loss, the frequency of blood transfusions and might increase recurrence rate of fibroids, however it should be taken into account that some results are mainly based on cohort studies. Other pre-treatment agent ulipristal acetate has not been investigated sufficiently for relevant surgical outcomes.
[Mh] Termos MeSH primário: Hormônio Liberador de Gonadotropina/análogos & derivados
Laparoscopia
Laparotomia
Norpregnadienos/administração & dosagem
Substâncias Protetoras/administração & dosagem
Miomectomia Uterina
[Mh] Termos MeSH secundário: Feminino
Hormônio Liberador de Gonadotropina/administração & dosagem
Seres Humanos
Complicações Pós-Operatórias/prevenção & controle
Cuidados Pré-Operatórios
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Norpregnadienes); 0 (Protective Agents); 33515-09-2 (Gonadotropin-Releasing Hormone); 79561-22-1 (LHRH, Ala(6)-Gly(10)-ethylamide-); YF7V70N02B (ulipristal acetate)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171017
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0186158


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[PMID]:28766313
[Au] Autor:Shen J; Che Y; Showell E; Chen K; Cheng L
[Ad] Endereço:Centre for Clinical Research and Training, Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 2140 Xie Tu Road, Shanghai, China.
[Ti] Título:Interventions for emergency contraception.
[So] Source:Cochrane Database Syst Rev;8:CD001324, 2017 08 02.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Emergency contraception (EC) is using a drug or copper intrauterine device (Cu-IUD) to prevent pregnancy shortly after unprotected intercourse. Several interventions are available for EC. Information on the comparative effectiveness, safety and convenience of these methods is crucial for reproductive healthcare providers and the women they serve. This is an update of a review previously published in 2009 and 2012. OBJECTIVES: To determine which EC method following unprotected intercourse is the most effective, safe and convenient to prevent pregnancy. SEARCH METHODS: In February 2017 we searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, Popline and PubMed, The Chinese biomedical databases and UNDP/UNFPA/WHO/World Bank Special Programme on Human Reproduction (HRP) emergency contraception database. We also searched ICTRP and ClinicalTrials.gov as well as contacting content experts and pharmaceutical companies, and searching reference lists of appropriate papers. SELECTION CRITERIA: Randomised controlled trials including women attending services for EC following a single act of unprotected intercourse were eligible. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane. The primary review outcome was observed number of pregnancies. Side effects and changes of menses were secondary outcomes. MAIN RESULTS: We included 115 trials with 60,479 women in this review. The quality of the evidence for the primary outcome ranged from moderate to high, and for other outcomes ranged from very low to high. The main limitations were risk of bias (associated with poor reporting of methods), imprecision and inconsistency. Comparative effectiveness of different emergency contraceptive pills (ECP)Levonorgestrel was associated with fewer pregnancies than Yuzpe (estradiol-levonorgestrel combination) (RR 0.57, 95% CI 0.39 to 0.84, 6 RCTs, n = 4750, I = 23%, high-quality evidence). This suggests that if the chance of pregnancy using Yuzpe is assumed to be 29 women per 1000, the chance of pregnancy using levonorgestrel would be between 11 and 24 women per 1000.Mifepristone (all doses) was associated with fewer pregnancies than Yuzpe (RR 0.14, 95% CI 0.05 to 0.41, 3 RCTs, n = 2144, I = 0%, high-quality evidence). This suggests that if the chance of pregnancy following Yuzpe is assumed to be 25 women per 1000 women, the chance following mifepristone would be between 1 and 10 women per 1000.Both low-dose mifepristone (less than 25 mg) and mid-dose mifepristone (25 mg to 50 mg) were probably associated with fewer pregnancies than levonorgestrel (RR 0.72, 95% CI 0.52 to 0.99, 14 RCTs, n = 8752, I = 0%, high-quality evidence; RR 0.61, 95% CI 0.45 to 0.83, 27 RCTs, n = 6052, I = 0%, moderate-quality evidence; respectively). This suggests that if the chance of pregnancy following levonorgestrel is assumed to be 20 women per 1000, the chance of pregnancy following low-dose mifepristone would be between 10 and 20 women per 1000; and that if the chance of pregnancy following levonorgestrel is assumed to be 35 women per 1000, the chance of pregnancy following mid-dose mifepristone would be between 16 and 29 women per 1000.Ulipristal acetate (UPA) was associated with fewer pregnancies than levonorgestrel (RR 0.59; 95% CI 0.35 to 0.99, 2 RCTs, n = 3448, I = 0%, high-quality evidence). Comparative effectiveness of different ECP dosesIt was unclear whether there was any difference in pregnancy rate between single-dose levonorgestrel (1.5 mg) and the standard two-dose regimen (0.75 mg 12 hours apart) (RR 0.84, 95% CI 0.53 to 1.33, 3 RCTs, n = 6653, I = 0%, moderate-quality evidence).Mid-dose mifepristone was associated with fewer pregnancies than low-dose mifepristone (RR 0.73; 95% CI 0.55 to 0.97, 25 RCTs, n = 11,914, I = 0%, high-quality evidence). Comparative effectiveness of Cu-IUD versus mifepristoneThere was no conclusive evidence of a difference in the risk of pregnancy between the Cu-IUD and mifepristone (RR 0.33, 95% CI 0.04 to 2.74, 2 RCTs, n = 395, low-quality evidence). Adverse effectsNausea and vomiting were the main adverse effects associated with emergency contraception. There is probably a lower risk of nausea (RR 0.63, 95% CI 0.53 to 0.76, 3 RCTs, n = 2186 , I = 59%, moderate-quality evidence) or vomiting (RR 0.12, 95% CI 0.07 to 0.20, 3 RCTs, n = 2186, I = 0%, high-quality evidence) associated with mifepristone than with Yuzpe. levonorgestrel is probably associated with a lower risk of nausea (RR 0.40, 95% CI 0.36 to 0.44, 6 RCTs, n = 4750, I = 82%, moderate-quality evidence), or vomiting (RR 0.29, 95% CI 0.24 to 0.35, 5 RCTs, n = 3640, I = 78%, moderate-quality evidence) than Yuzpe. Levonorgestrel users were less likely to have any side effects than Yuzpe users (RR 0.80, 95% CI 0.75 to 0.86; 1 RCT, n = 1955, high-quality evidence). UPA users were more likely than levonorgestrel users to have resumption of menstruation after the expected date (RR 1.65, 95% CI 1.42 to 1.92, 2 RCTs, n = 3593, I = 0%, high-quality evidence). Menstrual delay was more common with mifepristone than with any other intervention and appeared to be dose-related. Cu-IUD may be associated with higher risks of abdominal pain than mifepristone (18 events in 95 women using Cu-IUD versus no events in 190 women using mifepristone, low-quality evidence). AUTHORS' CONCLUSIONS: Levonorgestrel and mid-dose mifepristone (25 mg to 50 mg) were more effective than Yuzpe regimen. Both mid-dose (25 mg to 50 mg) and low-dose mifepristone(less than 25 mg) were probably more effective than levonorgestrel (1.5 mg). Mifepristone low dose (less than 25 mg) was less effective than mid-dose mifepristone. UPA was more effective than levonorgestrel.Levonorgestrel users had fewer side effects than Yuzpe users, and appeared to be more likely to have a menstrual return before the expected date. UPA users were probably more likely to have a menstrual return after the expected date. Menstrual delay was probably the main adverse effect of mifepristone and seemed to be dose-related. Cu-IUD may be associated with higher risks of abdominal pain than ECPs.
[Mh] Termos MeSH primário: Anticoncepção Pós-Coito/métodos
Anticoncepcionais Pós-Coito/administração & dosagem
[Mh] Termos MeSH secundário: Anticoncepção Pós-Coito/efeitos adversos
Anticoncepcionais Pós-Coito/efeitos adversos
Esquema de Medicação
Estradiol/administração & dosagem
Estradiol/efeitos adversos
Feminino
Seres Humanos
Dispositivos Intrauterinos de Cobre/efeitos adversos
Dispositivos Intrauterinos Medicados/efeitos adversos
Levanogestrel/administração & dosagem
Levanogestrel/efeitos adversos
Mifepristona/administração & dosagem
Mifepristona/efeitos adversos
Norpregnadienos/administração & dosagem
Norpregnadienos/efeitos adversos
Gravidez
Taxa de Gravidez
Ensaios Clínicos Controlados Aleatórios como Assunto
Sexo sem Proteção
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Contraceptives, Postcoital); 0 (Norpregnadienes); 320T6RNW1F (Mifepristone); 4TI98Z838E (Estradiol); 5W7SIA7YZW (Levonorgestrel); YF7V70N02B (ulipristal acetate)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170803
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD001324.pub5


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[PMID]:28730840
[Au] Autor:Lee JK; Schwarz EB
[Ad] Endereço:a Department of Obstetrics and Gynecology , Johns Hopkins University , Baltimore , MD , USA.
[Ti] Título:The safety of available and emerging options for emergency contraception.
[So] Source:Expert Opin Drug Saf;16(10):1163-1171, 2017 Oct.
[Is] ISSN:1744-764X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Emergency contraception (EC) is a way to significantly reduce the chance of becoming pregnant after an episode of unprotected intercourse. Considerable data support the safety of all available and emerging options for EC. Areas covered: This review presents a comprehensive summary of the literature regarding the safety of EC as well as directions for further study. PubMed was searched for all relevant studies published prior to June 2017. Expertopinion: All available methods of EC (i.e., ulipristal acetate pills, levonorgestrel pills, and the copper-IUD), carry only mild side effects and serious adverse events are essentially unknown. The copper IUD has the highest efficacy of EC methods. Given the excellent safety profiles of mifepristone and the levonorgestrel IUD, research is ongoing related to use of these products for EC.
[Mh] Termos MeSH primário: Anticoncepção Pós-Coito/métodos
Anticoncepcionais Pós-Coito/administração & dosagem
[Mh] Termos MeSH secundário: Animais
Anticoncepção Pós-Coito/efeitos adversos
Anticoncepcionais Pós-Coito/efeitos adversos
Feminino
Seres Humanos
Dispositivos Intrauterinos de Cobre/efeitos adversos
Levanogestrel/administração & dosagem
Levanogestrel/efeitos adversos
Norpregnadienos/administração & dosagem
Norpregnadienos/efeitos adversos
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Contraceptives, Postcoital); 0 (Norpregnadienes); 5W7SIA7YZW (Levonorgestrel); YF7V70N02B (ulipristal acetate)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170722
[St] Status:MEDLINE
[do] DOI:10.1080/14740338.2017.1354985


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[PMID]:28697115
[Au] Autor:Safrai M; Chill HH; Reuveni Salzman A; Shushan A
[Ad] Endereço:Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
[Ti] Título:Selective Progesterone Receptor Modulators for the Treatment of Uterine Leiomyomas.
[So] Source:Obstet Gynecol;130(2):315-318, 2017 Aug.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Uterine leiomyomas have drawn much attention since being described more than 200 years ago. These common benign uterine tumors often present with prolonged menstrual bleeding, pelvic pressure, and reproductive disorders and pose a true financial burden on health care systems all over the world. Over the past few decades, surgical treatment of uterine leiomyomas has received most of the focus compared with other treatment options. Choosing the appropriate surgical technique depends on many factors such as uterine leiomyoma location, patient's age, interest in future fertility, concomitant comorbidities, and the patient's preference. Pharmacologic treatments such as gonadotropin-releasing hormone agonists and antagonists have been used for the treatment of symptomatic uterine leiomyomas with only partial success. Myriad side effects and limited clinical results have rendered them less popular and have exposed a true need for new effective medical treatments. Recently, treatment with selective progesterone receptor modulators has shown promising results with shrinkage of uterine leiomyomas and a prolonged clinical effect. Selective progesterone receptor modulators provide hope for women with this challenging condition and are a promising new option in the armamentarium of medical treatments for uterine leiomyomas.
[Mh] Termos MeSH primário: Leiomioma/tratamento farmacológico
Norpregnadienos/uso terapêutico
Receptores de Progesterona/efeitos dos fármacos
Neoplasias Uterinas/tratamento farmacológico
[Mh] Termos MeSH secundário: Feminino
Hormônio Liberador de Gonadotropina/agonistas
Seres Humanos
Leiomioma/etiologia
Leiomioma/cirurgia
Neoplasias Uterinas/etiologia
Neoplasias Uterinas/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Norpregnadienes); 0 (Receptors, Progesterone); 33515-09-2 (Gonadotropin-Releasing Hormone); YF7V70N02B (ulipristal acetate)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170712
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002143


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[PMID]:28570936
[Au] Autor:Nandakumar R; Praditpan P; Westhoff CL; Cremers S
[Ad] Endereço:Division of Preventive Medicine, Department of Medicine and Irving Institute for Clinical and Translational Research, PH 10-105, 622 West 168th Street, New York, NY 10032, United States of America.
[Ti] Título:A UPLC-MS/MS method for the quantitation of Ulipristal acetate in human serum.
[So] Source:J Chromatogr B Analyt Technol Biomed Life Sci;1059:43-48, 2017 Aug 01.
[Is] ISSN:1873-376X
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:The progesterone receptor modulator, Ulipristal acetate (UPA) has proven to be an effective emergency contraceptive. Conflicting data has been reported that suggests different efficacy of the drug in different populations, which may be explained by the systemic exposure to the drug. A UPLC-MS/MS method was developed and validated for the accurate and sensitive measurement of UPA in human serum to address this matter. UPA was extracted from human serum using liquid-liquid extraction with a combination of hexane and dichloromethane. An analytical platform comprising reverse-phase chromatographic separation followed by mass spectrometric detection by positive electrospray ionization in multiple reaction monitoring was used for quantitation of UPA within 7min. The method was linear from 0.1 to 250ng/mL. The matrix effect was minimal and intra- and inter-assay precision and accuracy were all within the acceptable limits. UPA was found to be stable at all processing and storage conditions. The method was used to investigate the pharmacokinetics of UPA in a clinical trial designed to explore the effect of obesity on its bioavailability.
[Mh] Termos MeSH primário: Cromatografia Líquida de Alta Pressão/métodos
Norpregnadienos/sangue
Espectrometria de Massas em Tandem/métodos
[Mh] Termos MeSH secundário: Calibragem
Estabilidade de Medicamentos
Seres Humanos
Reprodutibilidade dos Testes
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Norpregnadienes); YF7V70N02B (ulipristal acetate)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170602
[St] Status:MEDLINE


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[PMID]:28472576
[Au] Autor:Mazza D
[Ad] Endereço:MD, MBBS, FRACGP, DRANZCOG, GradDipWomsHlth, is Head, Department of General Practice, School of Primary Health Care, Monash University, Victoria.
[Ti] Título:Ulipristal acetate: An update for Australian GPs.
[So] Source:Aust Fam Physician;46(5):301-304, 2017.
[Is] ISSN:0300-8495
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In Australia, use and understanding of emergency contraception among women remains relatively low. This is despite the introduction of levonorgestrel emergency contraceptive pills (ECPs) more than a decade ago. In April 2016, a new ECP with the active ingredient ulipristal acetate became available in Australia. OBJECTIVE: The aims of this article are to increase understanding of the recently introduced ulipristal acetate ECP, including its safety profile, effi-cacy and special considerations; dispel common myths and misconceptions about emergency contraception; and to provide guidance on emergency contraceptive management in general practice, considering the recent advances. DISCUSSION: Women are more receptive to information about emergency contraception that has been provided by a general practitioner (GP). As such, the availability of the ulipristal acetate ECP in Australia provides an important opportunity for GPs to help women prevent unplanned pregnancies.
[Mh] Termos MeSH primário: Anticoncepção Pós-Coito/métodos
Clínicos Gerais/tendências
Norpregnadienos/farmacologia
[Mh] Termos MeSH secundário: Adulto
Austrália
Anticoncepcionais Orais Hormonais/farmacologia
Anticoncepcionais Orais Hormonais/uso terapêutico
Feminino
Seres Humanos
Norpregnadienos/efeitos adversos
Norpregnadienos/uso terapêutico
Obesidade/complicações
Sobrepeso/complicações
Gravidez
Gravidez não Planejada
Atenção Primária à Saúde/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contraceptives, Oral, Hormonal); 0 (Norpregnadienes); YF7V70N02B (ulipristal acetate)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE


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[PMID]:28444736
[Au] Autor:Murji A; Whitaker L; Chow TL; Sobel ML
[Ad] Endereço:Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, 700 University Ave - 3rd Floor, Toronto, ON, Canada, M5G 1Z5.
[Ti] Título:Selective progesterone receptor modulators (SPRMs) for uterine fibroids.
[So] Source:Cochrane Database Syst Rev;4:CD010770, 2017 Apr 26.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Uterine fibroids are smooth muscle tumours arising from the uterus. These tumours, although benign, are commonly associated with abnormal uterine bleeding, bulk symptoms and reproductive dysfunction. The importance of progesterone in fibroid pathogenesis supports selective progesterone receptor modulators (SPRMs) as effective treatment. Both biochemical and clinical evidence suggests that SPRMs may reduce fibroid growth and ameliorate symptoms. SPRMs can cause unique histological changes to the endometrium that are not related to cancer, are not precancerous and have been found to be benign and reversible. This review summarises randomised trials conducted to evaluate the effectiveness of SPRMs as a class of medication for treatment of individuals with fibroids. OBJECTIVES: To evaluate the effectiveness and safety of SPRMs for treatment of premenopausal women with uterine fibroids. SEARCH METHODS: We searched the Specialised Register of the Cochrane Gynaecology and Fertility Group, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and clinical trials registries from database inception to May 2016. We handsearched the reference lists of relevant articles and contacted experts in the field to request additional data. SELECTION CRITERIA: Included studies were randomised controlled trials (RCTs) of premenopausal women with fibroids who were treated for at least three months with a SPRM. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed all eligible studies identified by the search. We extracted data and assessed risk of bias independently using standard forms. We analysed data using mean differences (MDs) or standardised mean differences (SMDs) for continuous data and odds ratios (ORs) for dichotomous data. We performed meta-analyses using the random-effects model. Our primary outcome was change in fibroid-related symptoms. MAIN RESULTS: We included in the review 14 RCTs with a total of 1215 study participants. We could not extract complete data from three studies. We included in the meta-analysis 11 studies involving 1021 study participants: 685 received SPRMs and 336 were given a control intervention (placebo or leuprolide). Investigators evaluated three SPRMs: mifepristone (five studies), ulipristal acetate (four studies) and asoprisnil (two studies). The primary outcome was change in fibroid-related symptoms (symptom severity, health-related quality of life, abnormal uterine bleeding, pelvic pain). Adverse event reporting in the included studies was limited to SPRM-associated endometrial changes. More than half (8/14) of these studies were at low risk of bias in all domains. The most common limitation of the other studies was poor reporting of methods. The main limitation for the overall quality of evidence was potential publication bias. SPRM versus placebo SPRM treatment resulted in improvements in fibroid symptom severity (MD -20.04 points, 95% confidence interval (CI) -26.63 to -13.46; four RCTs, 171 women, I = 0%; moderate-quality evidence) and health-related quality of life (MD 22.52 points, 95% CI 12.87 to 32.17; four RCTs, 200 women, I = 63%; moderate-quality evidence) on the Uterine Fibroid Symptom Quality of Life Scale (UFS-QoL, scale 0 to 100). Women treated with an SPRM showed reduced menstrual blood loss on patient-reported bleeding scales, although this effect was small (SMD -1.11, 95% CI -1.38 to -0.83; three RCTs, 310 women, I = 0%; moderate-quality evidence), along with higher rates of amenorrhoea (29 per 1000 in the placebo group vs 237 to 961 per 1000 in the SPRM group; OR 82.50, 95% CI 37.01 to 183.90; seven RCTs, 590 women, I = 0%; moderate-quality evidence), compared with those given placebo. We could draw no conclusions regarding changes in pelvic pain owing to variability in the estimates. With respect to adverse effects, SPRM-associated endometrial changes were more common after SPRM therapy than after placebo (OR 15.12, 95% CI 6.45 to 35.47; five RCTs, 405 women, I = 0%; low-quality evidence). SPRM versus leuprolide acetate In comparing SPRM versus other treatments, two RCTs evaluated SPRM versus leuprolide acetate. One RCT reported primary outcomes. No evidence suggested a difference between SPRM and leuprolide groups for improvement in quality of life, as measured by UFS-QoL fibroid symptom severity scores (MD -3.70 points, 95% CI -9.85 to 2.45; one RCT, 281 women; moderate-quality evidence) and health-related quality of life scores (MD 1.06 points, 95% CI -5.73 to 7.85; one RCT, 281 women; moderate-quality evidence). It was unclear whether results showed a difference between SPRM and leuprolide groups for reduction in menstrual blood loss based on the pictorial blood loss assessment chart (PBAC), as confidence intervals were wide (MD 6 points, 95% CI -40.95 to 50.95; one RCT, 281 women; low-quality evidence), or for rates of amenorrhoea (804 per 1000 in the placebo group vs 732 to 933 per 1000 in the SPRM group; OR 1.14, 95% CI 0.60 to 2.16; one RCT, 280 women; moderate-quality evidence). No evidence revealed differences between groups in pelvic pain scores based on the McGill Pain Questionnaire (scale 0 to 45) (MD -0.01 points, 95% CI -2.14 to 2.12; 281 women; moderate-quality evidence). With respect to adverse effects, SPRM-associated endometrial changes were more common after SPRM therapy than after leuprolide treatment (OR 10.45, 95% CI 5.38 to 20.33; 301 women; moderate-quality evidence). AUTHORS' CONCLUSIONS: Short-term use of SPRMs resulted in improved quality of life, reduced menstrual bleeding and higher rates of amenorrhoea than were seen with placebo. Thus, SPRMs may provide effective treatment for women with symptomatic fibroids. Evidence derived from one RCT showed no difference between leuprolide acetate and SPRM with respect to improved quality of life and bleeding symptoms. Evidence was insufficient to show whether effectiveness was different between SPRMs and leuprolide. Investigators more frequently observed SPRM-associated endometrial changes in women treated with SPRMs than in those treated with placebo or leuprolide acetate. As noted above, SPRM-associated endometrial changes are benign, are not related to cancer and are not precancerous. Reporting bias may impact the conclusion of this meta-analysis. Well-designed RCTs comparing SPRMs versus other treatments are needed.
[Mh] Termos MeSH primário: Antineoplásicos Hormonais/uso terapêutico
Estrenos/uso terapêutico
Leiomioma/tratamento farmacológico
Mifepristona/uso terapêutico
Norpregnadienos/uso terapêutico
Oximas/uso terapêutico
Receptores de Progesterona/antagonistas & inibidores
Neoplasias Uterinas/tratamento farmacológico
[Mh] Termos MeSH secundário: Amenorreia/tratamento farmacológico
Feminino
Seres Humanos
Leuprolida/uso terapêutico
Menstruação/efeitos dos fármacos
Dor Pélvica/tratamento farmacológico
Qualidade de Vida
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Antineoplastic Agents, Hormonal); 0 (Estrenes); 0 (Norpregnadienes); 0 (Oximes); 0 (Receptors, Progesterone); 320T6RNW1F (Mifepristone); 72W09924WP (asoprisnil); EFY6W0M8TG (Leuprolide); YF7V70N02B (ulipristal acetate)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170427
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD010770.pub2



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