Current status and challenges of drug development for hormonal treatment of endometriosis: a systematic review of randomized control trials

Objective: The aim of this systematic review is to summarize the data obtained from randomized controlled trials looking at new pharmacologic treatments for endometriosis published over the last decade with a focus on hormonal therapeutic options for endometriosis-associated pelvic pain, excluding studies focusing on fertility. Methods: We identified relevant original studies in the English language through a search of the MEDLINE, Scopus, and EMBASE (2012 to present) databases using the appropriate MeSH terms and applying the article type filter ''randomized controlled trials''. A total of 219 records were found during the electronic search. After a detailed evaluation and review of the manuscripts, 11 primary articles met the inclusion criteria. A systematic review of the data was conducted. Results: This review included several emerging drug therapies for endometriosis-associated pelvic pain. Randomized control trials showed promising results with several oral GnRH antagonists (elagolix, relugolix, ASP1707, linzagolix). However, studies of other hormonal agents such as aromatase inhibitors and SPRMs have not yielded significant or new advantages. SERMs have not been represented in randomized control trials and have failed to demonstrate clinical efficacy. Conclusion: Although numerous novel agents are being investigated for the treatment of endometriosis, there is still no significant progress in the development of curative rather than suppressive drugs. Therefore, further efforts are needed to develop an effective, and hopefully curative treatment for this chronic, costly, and overwhelming disease.