Suppression of pituitary-gonadal function by a potent new luteinizing hormone-releasing hormone antagonist in normal men

LHRH antagonists compete with endogenous LHRH for binding to receptors on pituitary gonadotrophs and thereby inhibit gonadal function by suppressing gonadotropin secretion. Westudied the effects of a recently developed LHRH antagonist on the pituitary-gonadal axis in man. The antagonist Detirelix ([N-Ac-D-Nal(2)¹) D-pCl-Phe²)D-Trp³, D-hArg(Et₂)⁶, D-Ala¹⁰] LHRH) was given as a single sc injection to nine normal men at three dose levels (5, 10, and 20mg) at intervals of at least 7 days. Serum FSH, LH, and testosterone levels were measured before treatment, at frequent intervals for 48 h, and 72, 96, and 168 h after administration of the antagonist. Mean serum FSH levels decreased (P < 0.001) from 6.9 ± 0.5 (±SEM) mlU/mL to nadirs of 4.4 ± 1.1, 3.6 ± 0.9, and 4.1 ± 0.9 after the 5-, 10-, and 20-mg doses, respectively. Serum LH levels decreased (P < 0.001) from 6.2 ± 0.3 mlU/mL to nadirs of 3.3 ± 0.4, 2.8 ± 0.3, and 2.7 ± 0.3 after all three doses. Serumtestosterone levels decreased (P < 0.001) in a dose-dependent fashion from 5.1 ± 0.2 ng/mL to nadirs of 1.3 ± 0.3, 0.9 ± 0.3, and 0.6 ±0.1 after the same doses. After the initial testosterone decrease, however, escape occurred 12-28 h after the lower doses. The area under the response curve, describing hormone concentrations as a function of time during the study, diminished by 23 ± 2%, 36 ± 4%, and 36 ± 3% for FSH, by 14 ± 6%, 30 ± 6%, and 34 ± 5% for LH, and by 41 ± 5%, 58 ± 6%, and 68 ± 4% for testosterone with the same doses, respectively. The apparent plasma disappearance half-life of Detirelix by RIA was at least 41 h after all three doses. Detirelix elicited only a minor local reaction; no systemic side-effects were observed within the dose range used. These results indicate that this LHRH antagonist is a safe, highly potent inhibitor of the human pituitary-gonadal axis with an exceptionally long duration of action.