BACKGROUND AND PURPOSE: 

• Laughlin-Tommaso et al. (AJOG, 2019) compared uterine artery embolization vs MRI-guided focused ultrasound surgery for the treatment of fibroids

METHODS: 

• Randomized controlled trial (RCT) 
  • Fibroid Interventions: Reducing Symptoms Today and Tomorrow study (FIRSTT) study  
  • Women who declined to be randomized were also followed as a observational cohort group  
  • Premenopausal women  
  • Symptomatic uterine fibroids 
• Women either received 
  • Uterine artery embolization 
  • MRI-guided focused ultrasound surgery 
• Primary outcome: Re-intervention for fibroids within 36 months 
• Secondary outcomes  
  • Change in serum AMH levels to assess ovarian function | Fibroid symptoms | Quality of life | Pain | Sexual function 
• Results analyzed using a comprehensive cohort design

RESULTS: 

• 83 women (mean age, 44.4 years) were treated and analyzed using the comprehensive cohort design  
  • 43 in the magnetic resonance imaging–guided focused ultrasound surgery group  
    • 27 randomized 
  • 40 in the uterine artery embolization group  
    • 22 randomized 
• Baseline characteristics the same between treatment groups, except for higher fibroid load in the uterine artery embolization arm 
• The MRI ultrasound group had a higher risk of reintervention  
  • Hazard ratio (HR) 2.81 (95% CI, 1.01–7.79) 
• Uterine artery embolization showed a significantly greater absolute decrease in AMH levels at 24 months compared with MRI ultrasound group (P=0.03) 
• While quality of life and pain scores improved in both arms, uterine artery embolization arm showed greater benefit (P≤0.006)  
  • Differences persisted even after adjusting for baseline quality of life and pain scores  
• Higher pretreatment AMH level and younger age at treatment increased the overall risk of reintervention

CONCLUSION: 

• Authors acknowledge a limitation of this study is that they did not meet their desired sample size and many women preferred to be in an observational cohort rather than be randomized  
• Uterine artery embolization led to lower uterine leiomyoma associated re-intervention rates and greater improvement in symptoms, compared to MRI-guided ultrasound  
• AMH was a predictor of outcome and authors suggest that impairment of ovarian reserve may mediate fibroid treatment  
  • More robust ovarian reserve may mitigate the treatment effect  
• Authors also point out that since the study’s completion, there is newer technology available for MRI-guided ultrasound surgery and reintervention rates may be more comparable to uterine artery embolization

Learn More – Primary Sources: 

FIRSTT study: randomized controlled trial of uterine artery embolization vs focused ultrasound surgery

Related ObG Topics:

Uterine Artery Embolization or Focused Ultrasound for Uterine Fibroids?

Uterine Artery Embolization or Hysterectomy for Fibroids?

What Uterine-Sparing Treatment for Fibroids Has the Best Outcomes?