Laparoscopic intraperitoneal injection of human interferon-alpha2b in the
treatment of pelvic endometriosis: a new modality
Clinical Case Report Abstract From
Laparoscopic intraperitoneal injection of human
interferon-alpha2b in the treatment of pelvic endometriosis: a new modality
Ali AF; Fateen B; Ezzet A; Badawy H; Ramadan A; El-tobge A
Infertility Research Center, Cairo, Egypt.
Obstet Gynecol 2000 Apr 01;95 Suppl 1(4):S47-S48
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Background: Some reports have stated that an immunologic
alteration plays a role in the development and progression of endometriosis.
Once endometrial cells are implanted ectopically, they may produce additional
changes through a defect in cellular or humoral immunity. Natural killer cell,
cytokines, and peritoneal macrophages could determine the role of progression of
the disease. Therapeutic manipulation of the immune system in patients with
endometriosis may be worth mention. Braum et al (1992) suggested that macrophage
activators such as interferons (IFNs) could be useful in addition to hormone
suppression therapy, to control and eliminate the growth of endometrial ectopic
Objective: To use for the first time laparoscopic
intraperitonal injection of human IFN-alpha2b in the treatment of pelvic
Methods: Twenty-five infertile women were enrolled in the
study. They had pelvic endometriosis. The diagnosis was based on laparoscopy,
and CA 125 was measured in all cases. They were classified as the following:
Stage II-mild endometriosis (5 cases), Stage III-moderate endometriosis (10
cases), and Stage IV-severe endometriosis. We proposed a protocol of dosage
system. For Stage I-we used 3 million IU of IFN-alpha2b, for Stage II-6 million
units, for Stage IV-12 million IU. We directly injected the dosage through
laparoscopy. Objective measurement for evaluating the implant growth depends on
the measurement of the largest diameter and change of the degree of the stage of
endometriosis. Second-look laparoscopy was done 3 months later in all patients
and CA 125 measurement was also done. All the patients were evaluated clinically
for dyspareunia, painful defecation, and progressive dysmenorrhea. Vaginal
examination was done for cul-de-sac induration, fixed ovarian masses, and
uterosacral ligament nodularity.
Results: There was a statistically significant (P
<0.05) decrease in all symptoms and signs after treatment; the decrease was
proportional to the size and diameter of large implant and the degree of
endometriosis. There was a statistically significant decrease in the level of CA
125 after treatment (P <0.001). On laparoscopy, there was diminution of the
stage of disease. Grade II changed to grade I, grade III changed to grade II,
and grade IV changed to grade III. Complete disappearance of disease was noted
in 2 cases in grade II (20%) and in 2 cases in grade III (10%). In grade IV,
there was no reported case of complete disappearance of endometriosis.
Cumulative pregnancy rate in all three stages after treatment was 33.3%. No
reported side effects of treatment were noted.
Conclusions: Human IFN-alpha2b immune stimulatory therapy
significantly reduces the symptoms of endometriosis. Reduce the stage of the
disease, reduce CA 125 level, reduce the size of implant, and improve the
pregnancy rate, so we can say that this line is a break treatment in the field
of endometriosis. More studies are needed; closed, double-blind, controlled,
randomized studies are needed for better evaluation of the results of treatment.
Publication Type: JOURNAL ARTICLE; RECORD SUPPLIED BY PUBLISHER
PreMedline Identifier: 0010729506