Relugolix–estradiol–norethisterone (relugolix combination therapy [CT]) can be used, within its marketing authorisation, as an option for treating symptoms of endometriosis in adults of reproductive age who have had medical or surgical treatment for endometriosis.
What this means in practice
Relugolix CT must be funded in the NHS in England to treat symptoms of endometriosis in adults of reproductive age who have had medical or surgical treatment for endometriosis, if it is considered the most suitable treatment option. Relugolix CT must be funded in England within 90 days of final publication of this guidance.
There is enough evidence to show that relugolix CT provides benefits and value for money, so it can be used routinely across the NHS.
Why the committee made this recommendation
After pain relief and hormonal treatment, usual treatment options for endometriosis are gonadotropin-releasing hormone (GnRH) agonists and surgery. There is no cure for endometriosis, and there is an unmet need for long-term and non-invasive (non-surgical and not injected) treatments for its symptoms.
Clinical trial evidence shows that relugolix CT reduces pain compared with placebo. Relugolix CT has not been directly compared in a clinical trial with usual treatment. Indirect comparisons suggest that it is likely to reduce pelvic pain almost as well as GnRH agonists. But it is unclear how well relugolix CT works compared with surgery.
The cost-effectiveness estimates for relugolix CT compared with GnRH agonists and surgery are within the range that NICE considers an acceptable use of NHS resources. So, relugolix CT is recommended.