Do heavier women benefit from a higher dose of leuprolide acetate for suppression of serum estradiol?

OBJECTIVE: To determine if heavier women benefit from a higher dose of the gonadotropin-releasing hormone analogue leuprolide acetate (LA) depot in terms of suppression of serum estradiol. METHODS: This was a retrospective analysis of the effect of LA depot 3.75 mg and 7.5 mg on serum estradiol from a multicenter, double-blind, parallel-group, 12-week study of women with anemia due to bleeding from uterine leiomyomata. Serum estradiol levels were obtained at baseline and at week 12. Patients were divided into weight quartiles according to their baseline weight in kilograms: 46-<64, 64-<72, 72-<89, 89-159 (pounds-102-<140, 140-<159, 159-<196, 196-350). RESULTS: At baseline there was no statistically significant difference in estradiol level between groups as a whole or within weight quartiles. Within each group there was no relationship between weight and baseline estradiol. At week 12, whereas estradiol levels were significantly greater in the heavier patients in each of the groups (LA 3.75 mg, p = 0.044; LA 7.5 mg, p = 0.002), there was no significant difference in estradiol between groups as a whole or within any of the weight quartiles. Moreover, at week 12 there was no significant difference between groups in the percentage of patients with estradiol suppressed to the menopausal range. CONCLUSION: Heavier women do not benefit from a higher dose of LA depot (7.5 vs. 3.75 mg) for suppression of serum levels of estradiol.

Leuprolide acetate depot and hormonal add-back in endometriosis: a 12-month study. Lupron Add-Back Study Group.

OBJECTIVE: To evaluate the efficacy and safety of a GnRH agonist, leuprolide acetate depot, alone and in combination with three hormonal add-back regimens in the management of endometriosis-associated pelvic pain. METHODS: Two hundred and one patients were enrolled in this multicenter, randomized, double-blind, 1-year trial. All patients were given an intramuscular injection of leuprolide acetate depot 3.75 mg every 4 weeks. Patients were assigned to one of four treatment groups: Group A received placebos for progestin and estrogen, group B received norethindrone acetate 5 mg daily and placebo for estrogen, group C received norethindrone acetate 5 mg and conjugated equine estrogens 0.625 mg daily, and group D received norethindrone acetate 5 mg and conjugated equine estrogens 1.25 mg daily. Pelvic pain scores were assessed monthly, and bone density was measured after 24 and 52 weeks. RESULTS: By week 8, all four groups showed significant improvement in pelvic pain scores compared with baseline levels. A higher proportion of group D patients terminated the study prematurely due to a lack of improvement in symptoms. Group A experienced a 6.3 +/- 2.3% (P < or = .001) loss in bone density after 52 weeks of treatment, whereas bone density was preserved in all three add-back groups. CONCLUSION: The use of leuprolide acetate depot in combination with norethindrone acetate 5 mg alone, or with norethindrone acetate and conjugated equine estrogens 0.625 mg, provides effective suppression of pelvic pain symptoms associated with endometriosis while protecting against bone loss.

An unusual presentation of gonococcal arthritis in an HIV positive patient.

A 27 year old, HIV positive, homosexual man was admitted for evaluation and treatment of acute oligoarticular arthritis. Gonococcal arthritis was found in a single hip and a single sternoclavicular joint, which is an unusual distribution for this bacterial pathogen.