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臨床婦人科産科75巻11号

2021年11月発行

文献概要

今月の臨床 月経異常に対するホルモン療法を極める!―最新エビデンスと処方の実際 月経困難症・過多月経 黄体ホルモン製剤

SPRMの展望

著者: 松岡正造1

所属機関: 1順天堂大学医学部附属練馬病院産科婦人科

ページ範囲:P.1068 - P.1073

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●選択的プロゲステロン受容体モジュレーター(SPRM)はプロゲステロン受容体に結合し,作用,拮抗あるいは両方の作用をもつ薬剤である.

●SPRMは緊急避妊や人工妊娠中絶薬,子宮筋腫の治療薬として用いられている.

●SPRMは第Ⅱ相臨床試験においてGnRH analogの効果と同等以上に子宮筋腫のサイズを減少させ,子宮からの出血を減少させた.

参考文献

1)Larner JM, et al : Circulating concentrations of the antiprogestins CDB-2914 and mifepristone in the female rhesus monkey following various routes of administration. Hum Reprod 15 : 1100-1106, 2000
2)Hild SA, et al : CDB-2914 : anti-progestational/anti-glucocorticoid profile and post-coital anti-fertility activity in rats and rabbits. Hum Reprod 15 : 822-829, 2000
3)北村邦夫:選択的プロゲステロン受容体修飾薬と避妊.HORM FRONT GYNECOL 23 : 71-77, 2016
4)Glasier AF, et al : Ulipristal acetate versus levonorgestrel for emergency contraception : a randomised non-inferiority trial and meta-analysis. Lancet 375 : 555-562, 2010
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6)Donnez J, et al : Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med 366 : 421-432, 2012
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12)Matsuo H, et al : Increased expression of Bcl-2 protein in human uterine leiomyoma and its up-regulation by progesterone. J Clin Endocrinol Metab 82 : 293-299, 1997
13)Ohara N, et al : Comparative effects of SPRM asoprisnil(J867) on proliferation, apoptosis, and the expression of growth factors in cultured uterine leiomyoma cells and normal myometrial cells. Reprod Sci 14(8 Suppl) : 20-27, 2007
14)Sasaki H, et al : A novel selective progesterone receptor modulator asoprisnil activates tumor necrosis factor-related apoptosis-inducing ligand(TRAIL)-mediated signaling pathway in cultured human uterine leiomyoma cells in the absence of comparable effects on myometrial cells. J Clin Endocrinol Metab 92 : 616-623, 2007
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16)Spitz IM : Clinical utility of progesterone receptor modulators and their effect on the endometrium. Curr Opin Obstet Gynecol 21 : 318-324, 2009
17)Bouchard P, et al : Selective progesterone receptor modulators in reproductive medicine ; pharmacology, clinical efficacy and safety. Fertil Steril 96 : 1175-1189, 2011
18)Donnez J, et al : Uterine fibroid management : from the present to the future. Hum Reprod Update 22 : 665-686, 2016
19)Donnez J, et al : Long-term treatment of uterine fibroids with ulipristal acetate. Fertil Steril 101 : 1565-1573.e1-e18, 2014
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21)Osuga Y, et al : Ulipristal acetate compared with leuprorelin acetate for Japanese women with symptomatic uterine fibroids : a phase III randomized controlled trial. Fertil Steril 116 : 189-197, 2021
22)Osuga Y, et al : Phase III long-term study bunnbento evaluate the efficacy and safety of ulipristal acetate in Japanese patients with uterine fibroids. J Obstet Gynaecol Res, 2021(in press)
23)Mutter GL, et al : The spectrum of endometrial pathology induced by progesterone receptor modulators. Modern Pathol 21 : 591-598, 2008
24)Engman M, et al : Mifepristone for treatment of uterine leiomyoma. A prospective randomized placebo controlled trial. Human Reprod 24 : 1870-1879, 2009
25)Wilkens J, et al : Effect of asoprisnil on uterine proliferation markers and endometrial expression of the tumour suppressor gene, PTEN. Human Reprod 24 : 1036-1044, 2009
26)Murji A, et al : Selective progesterone receptor modulators(SPRM) for uterine fibroids. Cochrane Database Syst Rev 4 : CD010770, 2017
27)Donnez J, et al : Long-term medical management of uterine fibroids with ulipristal acetate. Fertil Steril 105 : 165-173.e4, 2016
28)Donnez J, et al : Liver safety parameters of ulipristal acetate for the treatment of uterine fibroids : a comprehensive review of the clinical development program. Expert Opin Drug Saf 17 : 1225-1232, 2018
29)Taylor HS, et al : Treatment of endometriosis-associated pain with elagolix, an oral gnrh antagonist. N Engl J Med 377 : 28-40, 2017
30)Schlaff WD, et al : Elagolix for heavy menstrual bleeding in women with uterine fibroids. N Engl J Med 382 : 328-340, 2020

掲載誌情報

出版社:株式会社医学書院

電子版ISSN:1882-1294

印刷版ISSN:0386-9865

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