Efficacy of pathogenetically based antifibrotic therapy in combination treatment of endometriosis: A review

Endometriosis is a chronic, estrogen-dependent condition characterized by a significant fibrosing component, which substantially impacts the pain, reproductive function, and overall quality of life for affected individuals. Given the limitations of current therapeutic options and the high recurrence rates, there is a justified need to explore pathogenetic strategies to modify fibrosis and chronic inflammation. This review evaluates the latest findings on the role of fibrosis in the pathogenesis of endometriosis, along with the nature of the inflammatory and immune responses and their associations with pain-related, reproductive, and adhesive complications accompanying the disorder. In particular, the focus is on bovhyaluronidase azoximer as an antifibrotic, anti-inflammatory, and immunomodulatory agent used in the combined treatment regimen for endometriosis, particularly during the postoperative phase. The findings from preclinical investigations, along with 11 clinical trials involving over 1,200 patients, demonstrate reductions in pain severity, improvements in reproductive outcomes, decreased frequency and severity of adhesion formation, and a favorable safety profile associated with bovhyaluronidase azoximer administration. In light of the collective data, this review discusses the potential to incorporate antifibrotic therapy into standard care protocols for patients with endometriosis, as well as the directions for future clinical research, including optimizing dosing protocols, establishing the appropriate duration of therapy, and assessing long-term outcomes.