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The Role of Ethnicity in the Treatment of Uterine Fibroids With Ulipristal Acetate

      Study Objective

      In June 2013, Health Canada approved a new selective progesterone receptor modulator, Ulipristal Acetate (UPA), for the treatment of symptoms from uterine fibroids. Participants from the pivotal randomized trials consisted primarily of white Eastern European women. Our objective was to evaluate if there is a difference between Black and White women with respect to fibroid symptomatology at baseline and treatment effect following 3 months of UPA.

      Design

      Prospective cohort study.

      Setting

      Mount Sinai Hospital, a university-affiliated tertiary-care institution in Toronto, Canada.

      Patients

      Women initiated on UPA for symptoms from uterine fibroids were recruited by their gynecologist.

      Intervention

      Patients completed a survey at baseline and 3 months consisting of demographics, Aberdeen Bleeding Scale, Uterine Fibroid Symptom and Health Related Quality of Life Questionnaire (UFS-QoL). Uterine and fibroid ultrasound measurements were recorded. Patients were asked identify their ‘ethnic/cultural’ origin based on Statistics Canada pre-defined options.

      Measurements and Main Results

      There were 121 participants in the cohort: 35 self-identified as Black and 48 as White. At baseline, Black women had greater median uterine volumes, compared to white counterparts (598 vs 321 cm3, p<0.01). There were no baseline differences in median bleeding scores (40 vs 45), symptom severity scores (47 vs 55, p=0.2) and overall health-related quality of life (49 vs 42, p=0.26).
      Three-month follow-up data was available for 22 Black and 32 White patients. There were no significant differences between Black and White women in rates of amenorrhea (47% vs 59%), median change in bleeding scores (-31 vs -41), change in symptom severity score (-37 vs -34) and change in health-related quality of life (+45 vs +40). The percent change in volume of the largest fibroid was similar between groups (-14% vs -16%).

      Conclusion

      Black and White women experience similar symptom severity from uterine fibroids and have comparable response to a 3-month course of UPA.