The National Institute for Health and Care Excellence (Nice) has approved a groundbreaking daily pill for the treatment of endometriosis, offering new hope to the estimated 1.5 million women in the UK suffering from this debilitating condition.
The combination drug, relugolix–estradiol–norethisterone (also known as Ryeqo), represents the first long-term oral medication specifically licensed for endometriosis management. The treatment will be available to patients whose previous medical or surgical interventions have failed.
How Ryeqo Works
Ryeqo functions through a dual-action mechanism that targets the hormonal drivers of endometriosis. The medication blocks specific hormones that contribute to the condition while simultaneously providing necessary hormone replacement therapy. This approach addresses the underlying cause of endometriosis while mitigating potential side effects associated with hormone suppression.
Unlike existing injectable treatments that can initially worsen symptoms, Ryeqo offers several advantages. Patients can take the medication at home, experience faster symptom relief, and benefit from having multiple hormonal components combined into a single daily pill. This eliminates the need for frequent clinic visits for injections.
Helen Knight, director of medicines evaluation at Nice, highlighted the significance of this approval: "This new treatment marks a potential step-change in how we manage endometriosis, putting control back in patients' hands while ensuring value for the taxpayer. Instead of travelling to clinics for injections, there is now a daily tablet that can be taken at home."
The Burden of Endometriosis
Endometriosis occurs when tissue similar to the womb lining grows in other parts of the body, most commonly in the pelvis, bladder, and bowel. The condition affects approximately 1.5 million women and those assigned female at birth in the UK, according to data from Endometriosis UK.
Patients with endometriosis often experience debilitating pain, heavy menstrual bleeding, chronic fatigue, and fertility problems. These symptoms can significantly impact quality of life, affecting both personal relationships and professional capabilities.
Despite its prevalence, endometriosis remains challenging to diagnose. The NHS reports that patients typically wait nine years from the onset of symptoms to receive a formal diagnosis. This delay occurs largely because endometriosis symptoms can mimic those of other conditions, including fibroids, pelvic inflammatory disease, and irritable bowel syndrome.
Approval Process and Availability
Nice initially rejected Ryeqo for NHS use. However, the manufacturer, Gedeon Richter, subsequently provided additional evidence addressing concerns about the treatment's effectiveness and value for money, leading to the reversal of this decision.
The medication is expected to benefit approximately 1,000 endometriosis patients annually. With a list price of £72 for a 28-day supply (excluding VAT), the treatment represents a significant investment in improving care for those with this chronic condition.
Knight emphasized additional benefits of the oral medication: "The treatment can also be stopped and started more easily, which is particularly important for those planning to have children and for managing side-effects. This convenience not only benefits patients but reduces pressure on NHS services."
Patient Impact
For the many women who have struggled with limited treatment options, Ryeqo represents a significant advancement in endometriosis care. The ability to take medication at home without clinic visits for injections offers greater autonomy and potentially less disruption to daily life.
The approval of this first-of-its-kind treatment marks an important milestone in addressing the unmet needs of endometriosis patients in the UK, potentially improving quality of life for thousands of sufferers who have not responded to existing therapies.
