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Objective: To study the therapeutic effect of triptorelin acetate combined with psychological intervention on the chil-dren with idiopathic central precocious puberty. Methods: Totally 40 cases of central precocious puberty were randomly divided into the observation group and the control group with 20 ones in each. The control group was injected with triptorelin acetate, once every 28 d; the observation group was given psychological intervention on the basis of the control group, once every 28 d. The emotional stabili-ty, depressive psychology, treatment compliance, height, body weight, growth rate, bone age ( BA) and adult height ( PAH) of the two groups before and after one-year treatment were observed and compared. Results: After the one-year treatment, the scores of emo-tional stability and depressive psychological HAMD in the observation group were significantly lower than those in the control group (P<0. 05), and the medication compliance was significantly higher in the observation group than that in the control group (P<0. 05). The growth rate and adult height of the children in the observation group were significantly higher than those in the control group (P<0. 05). Conclusion: Triptorelin acetate combined with psychological intervention in the treatment of children with idiopathic central precocious puberty can relieve depression, stabilize mood and improve medication compliance, and also effectively improve the growth rate and adult prediction height of the children.
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Objective To establish an in vitro accelerated release method of triptorelin acetate microspheres with good in vi-tro/in vivo correlation(IVIVC). Methods The in vivo release of triptorelin acetate from microspheres was obtained by residual method in rats. Influences of pH value,concentration of ethanol,temperature,rotation speed and concentration of antiseptic on the in vitro accel-erated release were studied,then the correlation between in vitro accelerated release and in vivo release of the microspheres was estab-lished by adjusting the release conditions. Results The in vitro accelerated release medium of triptorelin acetate microspheres composed of 15%ethanol solution(containing 0.06%Tween 80 and 0.1%benzalkonium chloride)at 55℃with rotating rate of 200 r/min. The cumulative release of triptorelin acetate from microspheres was 87.35%at 30 h under accelerated release condition,equivalent to in vivo release for 30 days. The established in vitro accelerated release had a good correlation with that of in vivo(y=0.8845x+12.4510, R2=0.9938). Conclusion The in vitro accelerated release of triptorelin acetate microspheres could correlate well with in vivo release and has a potential application in rapid and effective evaluation of triptorelin acetate microspheres.
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OBJECTIVE:To observe clinical efficacy and safety of triptorelin acetate in the treatment of endometriosis after lap-aroscopy. METHODS:196 cases of endometriosis were randomly divided into experimental group and control group with 98 cases in each group according to admission sequence. Both groups received laparoscopic surgery. After surgery,experimental group was given triptorelin acetate by intramuscular injection,3.75 mg/time,every 4 weeks;control group was given gestrinone orally,2.5 mg/time,twice a week,for 5 months. The ovulation,menstrual recovery and the occurrence of ADR were observed in 2 groups. The endometriosis relapse of 2 groups were followed up for 1 year and observed. RESULTS:After treatment,the ovulation recov-ery time and menstrual recovery time of experimental group were all shorter than those of control group,with statistical signifi-cance(P<0.05). The incidence of ADR in experimental group(17.34%)was significantly lower than in control group(35.71%), with statistical significance(P<0.05). During follow-up period,the relapse rate of experimental group(7.14%)was significantly lower than that of control group(18.37%),with statistical significance(P<0.05). CONCLUSIONS:After laparoscopic surgery, triptorelin acetate can significantly improve therapeutic efficacy of endometriosis,reduce the occurrence of ADR.
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Objective To compare the clinical effects and influence on CA125,endometrial antibody of trip-torelin the treatment of endometriosis surgery endometriosis surgery,to provide reference for clinical treatment. Methods 60 patients with endometriosis surgery were randomly divided into 30 cases of I group and 30 cases of II group,I group was treated with mifepristone on the first days after menstruation 12.5mg/d,qd,II group was given triptorelin 3.75mg,every 28 days for 1 times,treated for 3 months,the symptoms and signs before and after treatment were observed,then menstruation and dysmenorrhea score were evaluated,Elbow vein blood was taken out for calculat-ing CA125 and serum antiendometrial antibody,the clinical efficacy were evaluated and the adverse reactions were observed,all patients were followed up for 1 years,then 1 years cumulative pregnancy rate were recorded.Results The CA125,EMab,menstrual score,dysmenorrhea score of I group and II group after the treatment were (18.2 ±2.8)U /mL and (8.8 ±3.2)U /mL,(405.2 ±141.1)pg/mL and (202.1 ±79.8)pg/mL,(18.85 ±6.32)score and (7.68 ± 4.19)score,(1.91 ±0.35)score and (0.95 ±0.63)score,all index of both group after treatment were significantly lower than those before treatment(t =8.433 and 14.824,7.659 and 14.578,20.772 and 26.286,15.853 and 19.513,P 0.05);the irregular vaginal bleeding rate of I group was 23.33%,the II group were 3.33%,χ2 =5.192,P <0.05.Conclusion Triptorelin and mifepristone has same clinical effect in endometriosis postoperative,but triptorelin can reduce more effectively the CA125 and anti endometrium antibody,abnormal vaginal bleeding and reduce dysmen-orrhea postoperative,postoperative recurrence rate and pregnancy rate is good,can be used as a recommended drugs in the treatment patients with endometriosis surgery.
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Objective To observe the gonadotropin analogue ( GnRHa) Triptorelin of idiopathic central pre-cocious puberty(ICPP) girls′body mass index(BMI) and final adult height(FAH).Methods 120 patients with idi-opathic central precocious puberty cases were summarized and track the return visit ,which.of 62 cases with ICPP girls Triptorelin treatment,6,12,18,24,36 months of observation and treatment of bone age (BA),the growth rate(GV), BMI,predicted height ( PAH) ,and life-long high and up to lifelong high BMI .The untreated group was also observed the relevant indicators such as BMI ,and lifelong.Results After treatment,the increase in BA was less than that in age.The PAH has improved with the growth of the treatment regimens .After treatment PAH 12,18,24,36 months PAH respectively[(153.4 ±7.1)cm,(154.6 ±6.2)cm,(155.7 ±4.7)cm,(156.9 ±5.9) cm], both were statisti-cally significant(t=2.23,2.67,3.01,2.88,all P0.05).Lifelong treatment and control groups,respectively[(158.2 ±3.9)cm,(153.7 ±2.8) cm],and between the two there is a statistically significant (t=3.04,P0.05). Conclusion Triptorelin can effectively suppress idiopathic central precocious sexual characteristics and bone age growth and improve adult height .There is no significant effect on the BMI .
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Objective To evaluate the diagnostic value of triptorelin stimulation test in disorders due to delayed puberty.Methods Triptorelin stimulation test was carried out in 128 teenagers with delayed puberty,due to idiopathic hypogonadotropic hypogonadism(IHH) in 77 cases and constitutional delayed puberty(CDP) in 51.Blood samples were obtained 15 min before and 0,30,60,and 120 min after tripotorelin administration,and the levels of LH and FSH were determined.An extended GnRH stimulation test was carried out in 3 patients with IHH.Results Peak LH,peak FSH,and LH increment were parameters with high diagnostic value.A cut-off point at 8.2 IU/L of peak LH showed a sensitivity of 87％ and a specificity of 80.4％ in the differential diagnosis of IHH and CDP.Conclusion Peak LH cut-off point at 8.2 IU/L of triptorelin stimulation test seems to be sufficient to confirm diagnosis of IHH and CDP.An extended GnRH stimulation test may distinguish hypothalamic from the pituitary hypogonadotropic hypogonadism.
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Objective To analyze half amount triptorelin in patients with endometriosis after application . Methods According to digifal table ,86 patients with endometriosis were randomly divided into the two groups:the observation group(43 cases)and the control group(43 cases).All patients were treated with laparoscopy .The patients in the observation group were treated through half amount triptorelin ,while the control group was treated through whole amount triptorelin .They were treated for six months .Serum carbohydrate antigen 125 ( CA125 ) and tumor necrosis factor-α( TNF-α) were measured before and after treatment .Results The groups of patients were successfully operated.The total effective rates in the control group were 97.7%in the control group and 95.3%in the observation group,there was no significant difference (χ2 =1.46,P>0.05).1-year follow-up after surgery,the control group had 5 cases of recurrence ,the recurrence rate was 11.6%,the observation group had 4 cases of recurrence ,the recurrence rate was 9.3%,there was no significant difference (χ2 =0.92,P>0.05).After treatment,serum CA125 and TNF-αwere significantly lowered,but levels of serum CA125 and TNF-αafter treatment had no significant difference (t=0.773,0.131,P>0.05).During treatment,the control group had 15 cases of adverse reactions ,the rate was 34.9%and the observation group had 5 cases of adverse reactions,the rate was 11.6%.The observation group should be significantly less than the control group (χ2 =6.78,P<0.05).Conclusion Half amount triptorelin had the quite effect with whole amout and fewer adverse reactions .
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PURPOSE: Long-acting gonadotropin-releasing hormone agonists (GnRHa) are commonly used to treat central precocious puberty (CPP) in Korea. Although rare, there have been reports on the characteristic of adverse reactions of GnRHa in CPP among the Korean population. This study was intended to report on our clinical experience regarding significant adverse reactions to long-acting GnRHa in CPP and early onset puberty and to evaluate the prevalence rate of serious side effects. METHODS: This retrospective study included children with CPP and early onset puberty, who were administered monthly with long-acting GnRHa (leuprolide acetate, triptorelin acetate) at the outpatient clinic of Department of Pediatrics, at Inha University Hospital, between January 2011 and December 2013. We analyzed the clinical characteristics of patients who experienced significant adverse reactions and evaluated the prevalence rate. RESULTS: Six serious side effects (0.9%) were observed among total of 621 CPP and early onset puberty children with GnRHa therapy. The number of sterile abscess formation was four in three patients (4 events of 621). Anaphylaxis occurred in only one patient, and unilateral slipped capital femoral epiphysis (SCFE) in another one patient. Anaphylaxis occurred after the 6th administration of the monthly depot triptorelin acetate. Unilateral SCFE developed in GnRHa therapy. CONCLUSION: Sterile abscess formation occurred in 0.6% of CPP and early onset puberty patients from the administration of a monthly depot GnRHa therapy. The occurrences of anaphylaxis and SCFE are extremely rare, but can have serious implications on patients. Clinicians should be aware of these potential adverse effects related to GnRHa therapy in CPP.
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Adolescent , Child , Humans , Abscess , Ambulatory Care Facilities , Anaphylaxis , Drug-Related Side Effects and Adverse Reactions , Gonadotropin-Releasing Hormone , Korea , Leuprolide , Pediatrics , Prevalence , Puberty , Puberty, Precocious , Retrospective Studies , Slipped Capital Femoral Epiphyses , Triptorelin PamoateABSTRACT
Objective To compare the outcomes in pregnancy between the patients with poor ovarian reservation receiving ultra-long-term down-regulation protocol and modified long-term protocol who were undergoing in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI),aiming at screening an optimal ovulation induction scheme.Methods Retrospectively analyzed the clinical data of 78 patients with poor ovarian reservation who underwent IVF or ICSI from October 2010 to July 2012.Forty-three patients received modified long-term protocol treatment (group A),with 0.375 mg long-acting triptorelin during the midluteal phase as well as superovulation start date plus alarelin (0.15 mg/d) to intramuscular injection of human chorionic gonadotropin (HCG) day.Thirty-five patients received ultra-long-term down-regulation protocol (group B).Triptorelin was injected intramuscularly in mid-luteal phase twice followed by triptorelin at a dose of 1.2-1.3 mg after 28 days of long-acting triptorehn treatment (1.5 mg).Gonadotropin was started 16 days after the second GnRHa injection.The dose of Gn,number of oocytes retrieved,number of embryos available,implantation rate,pregnancy rate,and miscarriage rate were recorded and compared between the two groups.Results There was no significant difference between the two groups in the mean age of participants,basal follicular number,FSH,the dose of Gn used,number of oocytes retrieved,number of embryos available,number of implanted embryos,Pregnancy rate(32.56％ vs.34.29％),implantation rate(18.75％ vs.20.97％) and miscarriage rate (0 vs.8.33％)(P ＞ 0.05).Conclusion No significant difference was found between the two groups in clinical pregnancy rate and abortion rate.But modified long-term protocol needs a shorter treatment period than the ultra-long-term protocol.Moreover,it reduces the risk of excessive suppression of pituitary function.Therefore,it takes advantages over the other in the clinical application.
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Long-acting formulations of gonadotropin-releasing hormone (GnRH) agonists are indicated for treating central precocious puberty. Leuprolide acetate and triptorelin acetate are widely used in Korea. Local reactions related to GnRH agonists, including erythematous macules, granulomas, subcutaneous nodules, and sterile abscesses, are the most side effects and sterile abscesses occur in less than 2-3% of treated patients. We report on two patients who had been injected with leuprolide acetate for the treatment of central precocious puberty and who subsequently presented with a sterile abscess at the injection sites. After the patients were switched to triptorelin acetate, one patient had another subcutaneous abscess at the injection site, and the other patient had no further problems. There are many theories as to the cause of these local reactions, but the mechanism has still not been elucidated. Further studies are required to identify the mechanism and the relationship between treatment effect and local reaction.
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Humans , Abscess , Gonadotropin-Releasing Hormone , Granuloma , Korea , Leuprolide , Puberty, Precocious , Triptorelin PamoateABSTRACT
Long-acting formulations of gonadotropin-releasing hormone (GnRH) agonists are indicated for treating central precocious puberty. Leuprolide acetate and triptorelin acetate are widely used in Korea. Local reactions related to GnRH agonists, including erythematous macules, granulomas, subcutaneous nodules, and sterile abscesses, are the most side effects and sterile abscesses occur in less than 2-3% of treated patients. We report on two patients who had been injected with leuprolide acetate for the treatment of central precocious puberty and who subsequently presented with a sterile abscess at the injection sites. After the patients were switched to triptorelin acetate, one patient had another subcutaneous abscess at the injection site, and the other patient had no further problems. There are many theories as to the cause of these local reactions, but the mechanism has still not been elucidated. Further studies are required to identify the mechanism and the relationship between treatment effect and local reaction.
Subject(s)
Humans , Abscess , Gonadotropin-Releasing Hormone , Granuloma , Korea , Leuprolide , Puberty, Precocious , Triptorelin PamoateABSTRACT
PURPOSE: The objective of this study was to evaluate the effect of gonadotropin releasing hormone analog (GnRHa) treatment on bone mineral density (BMD) in girls with central precocious puberty (CPP). Further we investigated the differences in the effect on BMD by using the GnRHa leuprolide-acetate and triptorelin. METHODS: Sixty-one females with CPP were enrolled in the study, the lumbar spine BMD was measured by dual energy x-ray absorptiometry before treatment, after one year (n = 61) and after two years (n = 24) of treatment. Lumbar spine BMD standard deviation scores (SDS) were compared according to chronological age (CA) and bone age (BA) for the whole group, as well as for the group A, treated with leuprolide-acetate (n = 40), and the group B, treated with triptorelin (n = 21). RESULTS: All subjects showed significant increment in BMD during treatment (P < 0.05). Lumbar spine BMD SDS for CA and BA showed no significant changes before and during treatment. Group A and group B, within each group, showed no significant changes in lumbar spine BMD SDS for CA and BA during treatment. CONCLUSION: Our study suggests that lumbar spine BMD was not impaired in girls treated with GnRHa for CPP and both leuprolide-acetate and triptorelin showed comparable effects on lumbar spine BMD during treatment.
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Female , Humans , Absorptiometry, Photon , Bone Density , Gonadotropin-Releasing Hormone , Leuprolide , Piperazines , Puberty, Precocious , Spine , Triptorelin PamoateABSTRACT
Objective: To study the effect of GnRH analog triptorelin in resensitizing cisplatin-resistant human ovarian cancer cells and to discuss the related mechanism. Methods: Cisplatin-resistant human ovarian cancer cell line OVCAR-3/CDDP was established in vitro. MTT assay was used to assess the inhibitory effects of triptorelin, cisplatin alone or a combination of both on OVCAR-3/CDDP cells. Flow cytometry was employed to observe the expression changes in epidermal growth factor receptor (EGFR) in different groups. Results: The drug restant index of OVCAR-3/CDDP cells was 13.42. The resensitizing fold of cisplatin combined with triptorelin was 3.80. The expression of EGFR had the most prominent decrease in OVCAR-3/CDDP cells in the combination group. Conclusion: Triptorelin can partially resensitize cisplatin- resistant OVCAR-3/CDDP cells, which might be related to the down-regulation of EGFR.
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Objective To study the effect of gonadotropin-releasing hormone-Ⅰ (GnRH-Ⅰ)agonist triptorelin and gonadotropin-releasing hormone- Ⅱ (GnRH-Ⅱ) on human endometrial carcinoma with different states of PTEN. Methods The endometrial carcinoma cells (Ishikawa, Ishikawa-PTEN, and Ishikawa-neo) were treated with different concentrations of triptorelin (10-11 to 10-5 mol/L) or GnRH-Ⅱ (10-11 to 10-5 mol/L). Thirty min later, serine/threonine protein kinase(Akt) and extracellular signal-regulated kinase (ERK) 1/2 activation were detected using western blot method. 48 h later, the cell proliferation, cell cycle and apoptosis were detected using methyl thiazolyl tetrazolium (MTT) and flow cytometry. 17β-estradiol (17β-E2, 10-8 mol/L) or the specific estrogen receptor (ER) antagonist, ICI182780I (10-6 mol/L) was added. After using the two drugs: triptorelin or GnRH-Ⅱ , the above parameters were detected again. Results After treated with different concentrations (10-11, 10-9, 10-7, 10-5 mol/L) of triptorelin and GnRH-Ⅱ, the cell growth was slowed, the percentage of G0/G1 phase cells increased, the percentage of G2/M and S phase cells decreased and the apoptosis rate increased in a dose-dependent manner (P <0. 01, P <0. 05). These changes were more obvious in Ishikawa. The apoptosis rate induced by GnRH-Ⅱ was higher than that by the same concentration of triptorelin in the three cell lines. Triptorelin and GnRH-Ⅱ inhibited the Akt and EBK1/2 activity in the endometrial carcinoma cells. 17β-E2 counteracted the effect of triptorelin and GnRH-Ⅱ on the endometrial carcinoma cells (P<0.01, P <0. 05). Conclusion Triptorelin and GnRH-Ⅱ can promote apoptosis rate of endometrial carcinoma cells and inhibit cell proliferation in a dose-dependent manner which may be caused by ERK1/2 and Akt activity inhibition, and is related to the status of PTEN and could be offset by 17β-E2.
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In order to assess the feasibility of subcutaneous administration of Triptorelin with 6-week intervals for the suppression of pituitary-gonadal axis and changes of clinical signs in girls with idiopathic central precocious puberty (ICPP), 46 girls with ICPP were treated with GnRHa.Triptorelin (Decapeptyl, 3.75 mg) was administered subcutaneously (SC) at 6-weeks intervals or intramuscularly (IM) at 4-weeks intervals randomly for more than 12 months consecutively. During GnRHa therapy, clinical parameters and laboratory data, including height, weight, pubertal stage,bone age, uterine volume and ovarian size, serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and estradiol (E2), were monitored and analyzed. It was found that both treatment regimes led to regression of precocious puberty and reversal of secondary sexual characteristics.Breast developments regressed. Uterine volume was decreased after treatment, but there was no statistically significant difference. Mean ovarian volume did not change significantly during treatment.The height velocity was decreased significantly from 6.3±1.4 cm/year to 5.8±1.2 cm/year in group SC and 6.7±1.3 cm/year to 5.4±1.0 cm/year in group IM, respectively. The rate of bone maturation was reduced significantly during treatment. The ratio of deltaBA/deltaCA was 1.2±0.2 or 1.3±0.3 at the onset of therapy and decreased significantly after the treatment to 0.7±0.2 or 0.9±0.1, respectively.The predicted adult height was increased significantly and progressively during therapy. The levels of serum LH, FSH and E2 returned to the prepubertal condition. No significant side effects of therapy were noted. The most common side effect during SC treatment was that a non-irritating, 1 cm in diameter mass was palpated at the site of subcutaneous injection in the abdominal wall of patients,which disappeared after 6- 12 weeks. Two girls had minimal withdrawal vaginal bleeding episodes after the first injection. It was concluded that both IM and SC triptorelin administrations were clinically effective. They induce profound suppression of hypothalamic-pituitary-gonadal axis while stabilizing height velocity, slowing bone maturation and increasing predicted adult height. These results suggest that subcutaneous injection of triptorelin in 6-weeks intervals at a dosage of 3.75 mg be a safe and acceptable regimen for ICPP
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Objective To evaluate the effectiveness and safety of triptorelin in the treatment of uterine leiomyoma. Methods A multi-center, prospective, randomly controlled clinical trial was carried out from Dec. 2002 to Mar. 2004 in three university hospitals. A total of 125 qualified patients with uterine leiomyoma were randomly divided into either triptorelin group (63 cases) treated with 3.75 mg triptorelin injected intramuscularly or leuprorelin group (62 cases) treated with 3.75 mg leuprorelin injected subcutaneously. Both drugs were injected every 28 days for a total of 3 months. Results All 125 patients finished the trial. The uterine volumes were similar before treatment between the triptorelin group and the leuprorelin group and were decreased significantly after drug therapy (P0.05).) The volumes of the largest leiomyoma decreased significantly after drug therapy (P0.05). Patients with serum level of 17?-estradiol 0.05). Dysmenorrhea, noncyclic pelvic pain and pressure-like symptoms were relieved quickly and remarkably in both groups after treatment. The rates of adverse event occurred in 71% of patients in both groups. The main side effects included flare-up effects and hypoestrogenic symptoms. Nine patients in the triptorelin group and 6 in the leuprorelin group received add-back therapy with tibolone 1.25-2.50 mg/d because of remarkable climacteric-like symptoms. Conclusion Treatment of uterine leiomyoma with triptorelin for 3 months is both effective and safe in Chinese women.
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Objective:To study the effect of GnRH analog triptorelin in resensitizing cisplatin-resistant human ovarian canc- er cells and to discuss the related mechanism.Methods:Cisplatin-resistant human ovarian cancer cell line OVCAR-3/CDDP was established in vitro.MTT assay was used to assess the inhibitory effects of triptorelin,cisplatin alone or a combination of both on OVCAR-3/CDDP cells.Flow cytometry was employed to observe the expression changes in epidermal growth factor receptor (EGFR)in different groups.Results:The drug restant index of OVCAR-3/CDDP cells was 13.42.The resensitizing fold of cisplatin combined with triptorelin was 3.80.The expression of EGFR had the most prominent decrease in OVCAR-3/CDDP cells in the combination group.Conclusion:Triptorelin can partially resensitize cisplatin-resistant OVCAR-3/CDDP cells,which might be related to the down-regulation of EGFR.