New Endometriosis Drugs?
Well hello there, Bestie! Let’s have a chat. The other day, I came across an article that was published earlier this year (2024) about a potential new drug for endometriosis. While I was doing a deep dive on that potential new drug, I found a couple articles about ANOTHER potential new endometriosis drug! If you’re part of the endometriosis (“endo”) community, you know what a huge deal this is. In the past four decades, there have been basically no new developments when it comes to endo treatment. Today, I wanted to talk about what these new drugs are and why these developments are so exciting!
Endometriosis is the growth of endometrial-like tissue outside of the uterus and it affects 1 in 10 women of reproductive age (1). Endometrial lesions can cause pain throughout the body and are even linked to infertility (1). While endo can be the cause of debilitating, chronic pain for many women, there is no cure. Most treatments up to this point are either hormonal or invasive, such as laparoscopic excision or hysterectomy surgeries. Physical therapy is a fantastic option for management of endometriosis-related pain and dysfunction, but cannot reduce the size or number of endometrial lesions. Basically, the only treatments we’ve had for the past 40 years that actually target the endometrial lesions are hormone-based or surgical. We are way overdue for some breakthroughs in the endo space!
So, what are these new drugs we’re talking about?
First, is a drug called dichloroacetate. Dichloroacetate has previously been used in children with metabolic disorders where difficulty breaking down lactic acid results in lactic acidosis (2). It has been shown to help reduce lactate production (3). Now enter: endometriosis. A 2014 study found that lactate concentration was higher in women with endometriosis than in women without (4). Later, in 2019, researchers looked into whether this increased lactate production was related to the spread of endometriosis cells and they found that the increased lactate created an environment that fostered the growth and spread of these cells (5). This 2019 study is now moving to the next phase of trials and will involve testing the drug with a group of 100 women (6). Half of the women will receive the drug and the other half will receive a placebo (6). The trial is expected to take over two years to complete, so we still have a bit of time to wait before we know the results, but the hope is that the new drug would become available in the UK within the next five years (6).
Next, we have an antibody called AMY109. Endometriosis is a progressive condition that is associated with inflammation and fibrosis (7). Typically, it continues to worsen over time as more and more lesions form. A protein called interleukin-8 (IL-8) is a major player when it comes to inflammatory response: it mediates the endometriosis inflammation response (8). Last year (2023), researchers created an antibody, which they call AMY109, which blocks the IL-8. They then studied the effects of this antibody on endometriosis in monkeys. The endometriosis in the monkeys studied was reported to be very similar to human endometriosis (7). The researchers found that monthly injections of the AMY109 antibody reduced the volume of endometrial lesions and reduced the fibrosis/adhesions present after 12 months of treatment (7). Now, the testing of the antibody is moving to human trials where both the safety and effectiveness of the treatment will be assessed (8).
This is an incredibly exciting time in the fight against endometriosis. Progress in this field is long overdue and women deserve so much more than the current options. For years, women have been told by their medical providers that their pain is “all in their heads” or that they should “get pregnant to manage their endometriosis” (9). While this is disturbing (to say the very least), endometriosis remains a very real and debilitating condition. Patients will often say that childbirth is a “walk in the park” compared to endometriosis pain.
I am so excited to see what happens in the next few years with endometriosis drug development, but I think we also have some work to do when it comes to just listening to women. Let’s take a woman at her word when she says she experiences pain. Let’s trust that she knows her body better than any healthcare provider ever could. Let’s get these new drugs developed, but let us also remember that they are only a piece of the puzzle and we still have some pretty large gaps to fill in.
Cheers to my endo warriors—hope is on the horizon.
XOXO,
Your Pelvic Bestie
References:
1. Rogers PA, D'Hooghe TM, Fazleabas A, Gargett CE, Giudice LC, Montgomery GW, Rombauts L, Salamonsen LA, Zondervan KT. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod Sci. 2009 Apr;16(4):335-46.
2. Stacpoole PW, Gilbert LR, Neiberger RE, Carney PR, Valenstein E, Theriaque DW, Shuster JJ. Evaluation of long-term treatment of children with congenital lactic acidosis with dichloroacetate. Pediatrics. 2008 May;121(5):e1223-8. doi: 10.1542/peds.2007-2062. Epub 2008 Apr 14. PMID: 18411236; PMCID: PMC3777225.
3. Barbee RW, Kline JA, Watts JA. Depletion of lactate by dichloroacetate reduces cardiac efficiency after hemorrhagic shock. Shock. 2000 Aug;14(2):208-14. doi: 10.1097/00024382-200014020-00022. PMID: 10947168.
4. Qi X, Zhang Y, Ji H, Wu X, Wang F, Xie M, Shu L, Jiang S, Mao Y, Cui Y, Liu J. Knockdown of prohibitin expression promotes glucose metabolism in eutopic endometrial stromal cells from women with endometriosis. Reprod Biomed Online. 2014 Dec;29(6):761-70. doi: 10.1016/j.rbmo.2014.09.004. Epub 2014 Sep 16. PMID: 25444511.
5. Horne AW, Ahmad SF, Carter R, Simitsidellis I, Greaves E, Hogg C, Morton NM, Saunders PTK. Repurposing dichloroacetate for the treatment of women with endometriosis. Proc Natl Acad Sci U S A. 2019 Dec 17;116(51):25389-25391. doi: 10.1073/pnas.1916144116. Epub 2019 Dec 2. PMID: 31792175; PMCID: PMC6925989.
6. https://www.theguardian.com/society/2023/mar/08/endometriosis-new-treatment-non-hormonal-drug-dichloroacetate
7. Nishimoto-Kakiuchi A, Sato I, Nakano K, Ohmori H, Kayukawa Y, Tanimura H, Yamamoto S, Sakamoto Y, Nakamura G, Maeda A, Asanuma K, Kato A, Sankai T, Konno R, Yamada-Okabe H. A long-acting anti-IL-8 antibody improves inflammation and fibrosis in endometriosis. Sci Transl Med. 2023 Feb 22;15(684):eabq5858. doi: 10.1126/scitranslmed.abq5858. Epub 2023 Feb 22. PMID: 36812343.
8. https://www.nnuh.nhs.uk/news/world-first-for-endometriosis-drug-trial/
9. Sirohi D, Freedman S, Freedman L, Carrigan G, Hey-Cunningham AJ, Hull ML, O'Hara R. Patient experiences of being advised by a healthcare professional to get pregnant to manage or treat endometriosis: a cross-sectional study. BMC Womens Health. 2023 Nov 30;23(1):638. doi: 10.1186/s12905-023-02794-2. PMID: 38037049; PMCID: PMC10688096.
10. https://www.telegraph.co.uk/global-health/women-and-girls/endometriosis-treatment-dca-trial-breakthrough/
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives
