Experience with bovhyaluronidaze azoximer used in the complex treatment of endometriosis: results of the island intra study

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Abstract

Background: Fibrosis is one of the key mechanisms responsible for developing endometriosis. Therefore, the effectiveness of treating various forms of endometriosis using antifibrotic therapy, such as Longidaza (bovhyaluronidaze azoximer), is of great importance for practice and requires further study.

Objective: To compare the results of the complex therapy with progestogen and Longidaza (3000 IU lyophilizate and 3000 IU suppositories) with progestogen monotherapy in patients with endometriosis and pain syndrome.

Materials and methods: The study included 72 patients aged 35 to 50 diagnosed with endometriosis. The patients were prescribed progestogen monotherapy (the comparison group included 35 women) or the combined therapy with progestogen and Longidaza (3000 IU lyophilizate injected intramuscularly once every 3 days, 10 injections for 30 days) followed by the administration of Longidaza suppositories 3000 IU rectally once every 5 days, a total of 20 suppositories (the main group included 37 women). The severity of pelvic pain was assessed using the VAS scale, and the quality of life was evaluated using the SF-20 questionnaire after 30 and 120 days. The data of the ultrasound examinations were analyzed to determine the frequency of the fan-shaped shadow of the small focal formations indicator.

Results: The treatment was completed by 66 patients, namely by 34 women from the main group and 32 women from the comparison group. On day 30, the incidence of complaints in the combination therapy group was lower that one in the monotherapy group: 18/34 (52.9%) versus 25/32 (78.1%), respectively (p=0.041). The analysis of pain syndrome using the VAS scale in each of the groups showed a significant decrease in pain levels compared to the initial level by the 30th day of therapy (р<0.001). In the combination therapy group, the pain level was more decreased than one in the monotherapy group: -2.5 [-6.0; -1.0] and -1.0 [-4.0; 0.0], respectively (p=0.039). According to the ultrasound results, the proportion of patients with the fan-shaped shadow of the small focal formations decreased from 15/34 (44.1%) to 9/34 (26.5%) (p=0.041) by the 120th day. The decrease was not significant in the monotherapy group, namely from 9/32 (28.1%) to 6/32 (18.8%) (p=0.317).

Conclusion: The results of the study demonstrate the benefits of using progestogen in combination with Longidaza in the treatment of patients with endometriosis.

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About the authors

S. O. Dubrovina

Rostov State Medical University, Ministry of Health of Russia

Author for correspondence.
Email: s.dubrovina@gmail.com

Professor, Dr. Med. Sci., Chief Researcher, Obstetrics and Pediatrics Research Institute,  Professor at the Department of Obstetrics and Gynecology No. 1

Russian Federation, Rostov-on-Don

M. A. Vovkochina

Rostov State Medical University, Ministry of Health of Russia

Email: jordan-85@inbox.ru

obstetrician-gynecologist, Obstetrics and Pediatrics Research Institute

Russian Federation, Rostov-on-Don

Yu. D. Berlim

Baskir State Medical University, Ministry of Health of Russia

Email: juliaberlim@yandex.ru

PhD, Teaching Assistant at the Department of Obstetrics and Gynecology

Russian Federation, Ufa

A. А. Aleksandrina

City Emergency Hospital

Email: anna221215@inbox.ru

obstetrician-gynecologist

Russian Federation, Rostov-on-Don

D. Yu. Bogunova

Rostov State Medical University, Ministry of Health of Russia

Email: bogunovadi@yandex.ru

doctor-PhD student of the 1st year of study, Department of Obstetrics and Gynecology No.1

Russian Federation, Rostov-on-Don

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2. Fig. 1. Proportions of patients with complaints and with complaints of chronic pelvic pain; p - significance level when comparing groups, Fisher test

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3. Fig. 2. Pain syndrome assessment using the VAS scale. Medians and interquartile range (IQR) are presented: "whiskers" - the range of values from maximum to minimum; dots - individual values of patients; p - significance level when comparing groups, Mann-Whitney test

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4. Fig. 3. Proportions of patients with the presence of the “fan-shaped shadow from small focal lesions” sign according to the ultrasound results; p is the significance level when comparing groups, Fisher’s test

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