Better Long-Term Outcomes With Uterine Artery Embolization vs MR-Guided Ultrasound for Uterine Fibroids
By Denise Baez
SAN ANTONIO, Tex -- November 5, 2017 -- Uterine artery embolization (UAE) is associated with improved long-term outcomes, compared with magnetic resonance (MR)-guided focused ultrasound for symptomatic uterine fibroids, according to a study presented here at the 2017 Annual Meeting of the American Society for Reproductive Medicine (ASRM).
Women who underwent MR-guided focused ultrasound for symptomatic uterine fibroids were more likely to have a second procedure for their symptoms compared with women who underwent UAE.
At 2 years, the cumulative incidence of a second fibroid procedure for women undergoing MR-guided focused ultrasound was 24% compared with 12% for women who underwent UAE (hazard ratio [HR] = 2.8; 95% confidence interval [CI], 1.1-7.8).
At baseline, symptom severity scores were 53.9 in the MR-guided ultrasound group and 53.1 in the UAE group. At 6 months post intervention, scores were 31.3 versus 13.2 (P< .001), respectively, and at 24 months, scores were 32.1 and 14.2 (P = .04).
At baseline, health-related quality of life (HRQL) scores were 52.5 in the MR-guided ultrasound group and 51.0 in the UAE group. HRQL scores increased significantly in the UAE group at 6 (91.2 vs 77.0; P = 002) and 24 months (92.4 vs 71.8 (P = .009) after the intervention.
At 2 years, cumulative incidence of menopause was 0% in the ultrasound group, compared with 9% in the UAE group.
“Earlier menopause after UAE may contribute to control of fibroid symptoms, as evidenced by better quality of life scores,” explained Shannon K. Laughlin-Tommaso, MD, Mayo Clinic, Rochester, Minnesota.
The FIRSTT study included 83 premenopausal women (mean age, 44.4 years) with symptomatic uterine fibroids from 2 studies: a randomised trial of UAE versus MR-guided ultrasound and an observational study of women undergoing these procedures but declined randomisation (49 were randomised).
The primary outcome was undergoing a second fibroid procedure for symptoms. Secondary endpoints included menopause and disease-specific quality of life scores.
[Presentation title: Long-Term Outcomes in a Randomized Controlled Trial of Uterine Artery Embolization and MR-Guided Focused Ultrasound: the First Study. Abstract O-61]