Clinical Implications and Integrative Treatment Modalities With Elagolix in Endometriosis
Dr Robert N. Taylor provides insight on emerging treatments and integrative therapies on the horizon with elagolix as well as real-world challenges using elagolix for endometriosis management.
Robert N. Taylor, MD, PhD: One of the questions that has been asked is, can we use these new drugs, the new elagolix kind of drugs, and as I mentioned, I think in the future we'll be having other similar compounds become available. They're in the process of undergoing FDA [United States Food and Drug Administration] approval currently, and we would expect that there might be even more options than these 2 doses of elagolix in the not-too-distant future. Can they be used in association with other kinds of therapies? As we develop a more and more holistic approach to women with endometriosis, and pain in particular, a lot of us are trying to incorporate lifestyle changes, meditation, exercise, as well as certain kinds of more natural remedies to try to help assuage the pain associated with endometriosis. I haven't had experience doing clinical trials with some of these compounds, but I'll tell you that in my own laboratory, I've been very interested in the effects of curcumin-like medications, including some synthetic versions of curcumin that are more biologically active as adjuvants, potentially, to markers for endometriosis pain. Hence, we've been interested in this.
One of the things to be concerned about a little bit is that elagolix is metabolized in the liver, through cytochrome P3A4 enzyme systems as well as the P-glycoprotein. And some of those metabolizing enzymes can be inhibited by certain herbal remedies. St. John's wort is the classic one that actually also utilizes the CYP3A4 pathway, and so with drugs that interfere with that, we might need to be kind of particularly careful. But it is hoped that we can sort of use elagolix as part of a regimen that would include other lifestyle modifications that might actually help with endometriosis pain. There are a couple of real-life challenges in the prescription of these medications. One is that even though the pharmaceutical company has been quite good at providing coupons for discounts on the medication, the cost of the medicine out of pocket is close to $1,000 per month. Some prior authorization issues and insurance formulary issues have come up in the past few years, and I know that a few of us have been kind of frustrated by the challenges to get some of these medications approved for our patients who haven't really been able to respond to other medications. It's been difficult to get patients directly on some of these drugs without having to go through a trial of the first and second level therapies before moving on to these more potent medications.
Transcript Edited for Clarity
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