Role of ethnicity in treating uterine fibroids with ulipristal acetate

Abstract

Objective: To study differences in treatment effect between black and white premenopausal women prescribed ulipristal acetate (UPA) for symptomatic uterine fibroids.

Design: Prospective observational cohort study.

Setting: Gynecology clinics.

Patient(s): Premenopausal women aged 18-55 years, at least one symptomatic uterine fibroid, UPA-naïve, and no contraindications for UPA treatment.

Intervention(s): One 3-month course of UPA at 5 mg daily.

Main outcome measure(s): Patients' ethnicity self-identification adapted from Statistics Canada National Household Survey. Change in fibroid symptoms according to Uterine Fibroid Symptoms Quality of Life Questionnaire symptom severity and health-related quality of life score. Bleeding symptoms and amenorrhea rates according to Aberdeen Bleeding Score.

Result(s): A total of 148 patients enrolled (45 black, 59 white, 44 other ethnicity). Black patients were younger (40.3 y vs. 44.5 y) with larger uteri (523 mL vs. 351 mL) than white counterparts. Baseline symptom severity was similar between groups. After 3 months of UPA treatment, both groups experienced similar improvements in symptom severity. White women had 52% greater improvement in bleeding score (-40.3 vs. -26.5) and were more likely to be amenorrheic at the end of treatment (66% vs. 41%). Both groups experienced adverse events at similar frequencies. Black women were more dissatisfied with UPA compared with white women (27.3% vs. 8%).

Conclusion(s): Black women had greater fibroid burden at baseline. Both ethnicities had similar improvement in fibroid symptomatology following UPA treatment, but white women experienced higher amenorrhea rates. Black women were more dissatisfied with UPA treatment, which may be related to the lower amenorrhea rates.

Keywords: Uterine leiomyoma; ethnicity; medical therapy; ulipristal acetate.