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Copenhagen,
Denmark
19 - 22 June 2005
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Endometriosis:
daily function improves with DMPA-SC 104
A Bergqvist
Karolinska Institutet
Department of Obstetrics and Gynaecology,
Danderyd,
Sweden
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Introduction
Chronic, recurrent pelvic pain associated
with endometriosis significantly impacts quality
of life. This report evaluates the effect of treatment
with depot medroxyprogesterone acetate subcutaneous
injection
104 mg/0.65 ml (DMPA-SC 104) or leuprolide acetate
(LA) on productivity measures in patients with endometriosis.
Materials and methods
A phase III, randomized, evaluator-blinded, comparator-controlled
clinical trial conducted in Europe, Asia, Latin
America and New Zealand assessed 6-month treatment
with DMPA-SC 104 (every 3 months) or LA (3.75 mg
every month or 11.25mg every 3 months) in premenopausal
women aged 18–49 years with laparoscopically
diagnosed endometriosis and persistent pain symptoms,
with 12 months of post-treatment followup.
Changes in productivity levels were measured through
patient-recorded endometriosis-impact diaries, and
included hours of employment and housework lost
due to absenteeism (planned work not attempted)
and presenteeism (productivity lost due to reduced
effectiveness) as a result of endometriosis symptoms.
Data were combined for women who were or were not
employed.
Results
The ITT population consisted of 299 patients (DMPA-SC
104 group, 153; LA group, 146). For employed work
(DMPA-SC 104 group, n=100; LA group, n=101), significant
improvement in mean hours lost occurred in both
treatment groups at end of treatment (month 6) and
at 1 year post-treatment
(month 18), compared with pre-treatment. In the
DMPA-SC 104 group, mean hours of employment lost
due to absenteeism improved from 19.1 at pre-treatment
to 4.9 at month 6 (P=0.002) and 3.6 at month 18
(P=0.023), and mean hours of employment lost due
to presenteeism improved from 40.8 at pre-treatment
to 26.6 at month 6 (P=0.005) and 28.0 at month 18
(P=0.012).
Results were similar in the LA group: mean hours
of employment lost due to absenteeism improved from
14.2 h at pre-treatment to 1.4 h at month 6 (P<0.001)
and 2.5 h at month 18 (P=0.001), and mean hours
of employment lost due to presenteeism improved
from 39.0 h at pre-treatment to 26.9 h at month
6 (P=0.002) and 17.3 h at month 18 (P=0.001). For
housework (DMPA-SC 104 group, n=132; LA group, N=130),
mean hours lost improved significantly in both groups
at the end of treatment (month 6) and at 1 year
posttreatment compared with pre-treatment. In the
DMPA-SC 104 group, mean housework hours lost due
to absenteeism at pre-treatment, month 6 and month
18 were 14.7, 3.9 (P<0.001) and 3.4 (P=0.001),
respectively; housework hours lost due to presenteeism
at these time points were 18.3, 7.3 (P=0.001) and
5.3 (P=0.001), respectively. Results were similar
in the LA group: mean hours lost
due to absenteeism at pre-treatment, month 6, and
month 18 were 17.2, 2.8 (P<0.001) and 1.4 (P<0.001),
respectively; hours lost due to presenteeism at
these time points were 18.2, 12.3 (P=0.003) and
8.8 (P=0.005), respectively.
Conclusions
Hours of productivity lost due to absenteeism and
presenteeism significantly improved from pre-treatment
to month 6 (end of treatment) in both groups, with
improvements maintained through 12 months post-treatment.
Treatment of endometriosis-associated pain with
either DMPA-SC 104 or LA provided sustained improvements
in daily functioning both on the job and at home.
