Double blind randomized controlled trial of efficacy of ormeloxifene for the treatment of fibroadenoma (The FIBROCENT study)

BACKGROUND

We evaluated the effectiveness of Ormeloxifene (Centchroman) on regression of Fibroadenoma in a double-blind randomized controlled trial.

METHODS

Patients with biopsy proven Fibroadenoma were enrolled between March 2023 and October 2023 and divided in two arms- Ormeloxifene group and Placebo group. Effectiveness of the treatment was evaluated using USG. No residual mass was defined as complete regression and more than 30% decrease in size was considered as partial regression.

RESULTS

A total of 130 consecutive patients with Fibroadenoma were randomized to Ormeloxifene group (n = 65) and Placebo Group (n = 65). Complete regression was observed in 9% (6/65) patients in Ormeloxifene group and 10.8% (7/65) in Placebo Group at the end of 12 weeks (p = 0.49). Twenty one patients taking Ormeloxifene reported adverse events as compared to none in the other group.

CONCLUSION

In our study Ormeloxifene was not found to be effective in treatment of fibroadenoma and had concerning side effects.

Evaluating the Effect of Ormeloxifene on Multiple Fibroadenomas and Mastalgia

INTRODUCTION

Most common benign breast conditions presenting in the breast clinics include fibroadenomas and mastalgia, both these conditions cause considerable anxiety in the patients. Among other treatment modalities, the hormonal drug treatments are gaining popularity. Ormeloxifene (centchroman) is an antiestrogenic drug which is shown to have effect in reducing the pain in mastalgia patients and the size of fibroadenoma.

OBJECTIVES

Ormeloxifene is selective antiestrogen and a nonsteroidal drug. It has a discerning antiestrogen action and hence is useful for the treatment of mastalgia and multiple small fibroadenomas. Hence, the objective of our study was to assess the effect of Ormeloxifene (centchroman) on multiple fibroadenoma and mastalgia.

MATERIALS AND METHODS

Patients with benign breast disease attending our surgery outpatient department from June 2016 to July 2017. Patients were started on Ormeloxifene 30 mg on alternate days for a period of 3 months. Patients were followed up to 6 months after the inception of the study. Parameters recorded include the Visual Analog Scale (VAS) for pain and ultrasonography for breast lump size.

RESULTS

Thirty patients were included in the study. We found very good response in the mastalgia; the VAS scores in these patients dropped from 10 to 3 in 90% in the 1^st week of introduction of the drug, and at the end of 1 month, almost all of the patients were painless. Overall final response was noted in terms of complete dissolution and change in the size was noted in 34% partial response in 46 %, no changes in 17 % and increase in size of fibroadenoma was noted in only one case.

CONCLUSION

Novex is proved to be safe drug for the treatment of mastalgia and fibroadenoma. Its results were great in mastalgia group. At the end of 6 months, the number of surgeries (if needed) decrease and there is considerable improvement in the patient satisfaction rate.

The effect of centchroman on mastalgia: a systematic review

OBJECTIVES

We carried out a systematic review of the literature to evaluate the effect of centchroman on mastalgia as well as any side effects.

METHODS

The databases of the Cochrane Library, Medline (PubMed), Embase, ProQuest and ClinicalTrials.gov were systematically searched. The quality of randomised controlled clinical trials (RCTs) was assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomised clinical trials. The quality of non-randomised clinical trials was assessed using the Cochrane risk of bias assessment tool for non-randomised studies of interventions (ROBINS-I). Owing to different outcomes reporting, a meta-analysis of the results was not possible.

RESULTS

Thirteen papers were included in the study. Of these, 12 showed a significant effect of centchroman in reducing breast pain at 3 months. One study that compared the effect of centchroman with that of tamoxifen reported a significant reduction in breast pain in both groups at 3 months; the difference between the two groups was not significant. Six studies showed the effectiveness of centchroman at 6 months. None of the papers reported any serious side effects of centchroman.

CONCLUSIONS

Since a meta-analysis could not be conducted and the quality of the papers was low, there was insufficient evidence to evaluate the effect of centchroman on mastalgia. It is therefore recommended to conduct well-designed RCTs to compare the effect of centchroman on mastalgia with that of a placebo or other medication.

Centchroman as First-line Treatment for Mastalgia: Results of an Open-label, Single-arm Trial

Mastalgia is a distressing symptom and may be severe enough to interfere with usual daily activities. Breast pain is either cyclical or noncyclical. Currently; multiple options are available for the treatment of mastalgia including hormonal and nonhormonal agents. This study was conducted to evaluate the role of centchroman as a nonhormonal first-line treatment for moderate to severe mastalgia. To accomplish this; a prospective open-label, single-arm study was done using the Pretest-Posttest Design. A total of 100 women suffering from mastalgia were grouped according to the characteristic pattern of breast pain (cyclic and noncyclic) and received centchroman 30 mg/day for 12 weeks followed by observation for 12 weeks. The efficacy analysis of centchroman was done by comparing median Visual Analog Scale score, median pain duration and side effects over time among the two groups. Centchroman significantly alleviates mastalgia with minimal side effects. The median pain score was significantly reduced over successive visits (1, 4, 12, and 24 weeks). The median pain duration decreased remarkably over time in comparison to the baseline (p = 0.001). Overall the response rate was 88% at the end of 12 weeks and 85% at the end of 24 weeks. The drug was found more effective with a quicker response in cyclic pattern of matalgia. Complete response was observed in 66% of cyclic mastalgia and 40% of noncyclic mastalgia patients at 1 week of therapy. The response was improved over time in both groups and at completion of treatment (12 weeks) 92% patients in cyclic group and 80% patients in noncyclic group were pain free. The effect of the drug persisted till the completion (24 weeks) of the study (p = 0.001). These results imply that centchroman is very effective in treating breast pain and can be prescribed as drug of first choice for mastalgia.