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[cityrat]

Hi all
I am wondering if any of you knowledgeable folks has heard of or had any experience with a med called Conbriza, made by Phizer I think. It is a SERM (Specific Estrogen Receptor Modulator) called Bazedoxifene. This drug inhibits estrogen’s effects on the breast and uterus. It is part of the treatment for some breast cancer patients. It is also one half of the HRT med Duavee/Duavive, as it keeps the estrogen (Premarin in this case) in the combined pill from causing buildup effect on the uterine lining. This is usually done by a progestin, which is why you need to take a progestin with estrogen if you have a uterus. So Duavee negates the need for a progestin and in doing so removes the breast cancer risk; it also may actually protect breast tissue.

The main drawbacks of Duavee are that it is an oral estrogen, a CIEE which some dont like, and it comes in only one strength so may need supplementation. More importantly it is back ordered and in the UK it has been discontinued.

I just recently heard in this forum of this Conbriza, which is exaclty the same SERM, bazedoxifene, that is in Duavee. It is apparently indicated for bone protection in menopausal women, in EU only. Though I have looked for something like this for ages, I only just read mention of it ins someone’s post on this forum. Oddly I could find no mention via google after 2011, though there was no mention of it being discontinued.

It seems as though it would be a great find, because it could possibly be paired with any estrogen at any strength such as an estradiol patch etc, solving both the stroke AND breast cancer issues. I would love to find out more about it. Does anyone know any info? Many thanks for any insight you can provide on this.

[Mary G]

cityrat, I trialled Conbriza (bazedoxifene 20mg) a few years ago.   I used it alongside testosterone and two pumps of Oestrogel every day.  Unfortunately it was a case of it worked but I didn't so I had to switch back to the dreaded Utrogestan.

I liked bazedoxifene and I didn't have any horrible side effects but my symptoms returned so I had to ditch it.  That said, there is no reason why it would not work for other women with a lower dose of oestrogen.

Conbriza is available in EU states and it costs about €30 per box of 28 capsules.

[Kathleen]

Hello cityrat.

The gynae I saw a about two years ago mentioned Duavee but I think she said it was being withdrawn from the UK because of poor sales.   Perhaps continue your search over the Internet?

If you turn up anything interesting please let us know.

Take care.

K.

[cityrat]

Mary G thanks for the response (I emailed you as well);  when I was taking Duavee before the recall, I needed more estrogen as well and my Dr. had me supplement with an estradiol patch of .25 (so about .65 mg estrogen total), which I believe is commonly done. I did ask her if the amount of bazidoxefene. in the Duavee was enough to protect the uterus even with the higher estrogen dose and she said yes absolutely. I don't know if that amount or the dosage in Conbriza would protect against any level of estrogen but definitely more than what's in the Duavee pill (.45 mg CEE) is ok.

I'm surprised more doctors in general aren't prescribing this combo, since everyone is so worried about the cancer risk from HRT. I suspect there is some business imperative or fear of lawsuits holding the drug companies back, as they could definitely do a better job of marketing it, and would do better to offer several dosage choices. Perhaps the liability of not being able to control off-label supplementation as we discussed here leaves them feeling vulnerable if something should happen.

While in wait and see mode for the Duavee, my doc has me on a long cycle regimen (prometrium 12 days every three months) with .9 of Premarin, as I tried the combined Prempro and didn't tolerate the progestin. But I would love to not have the DVT risk of an oral estrogen either, and it seems a patch or gel up through a medium dose would be covered by the baz. in Conbriza. I'm wondering why it isn't available in the US.  Even among the extremely knowlegeable people on this board people seem to know so little about it.

[Mary G]

cityrat, I think it's a pity that bazedoxifene is not more widely used because it's a good alternative to progesterone.   As far as the NHS is concerned, I think it's down to cost. 

Bazedoxifene is mainly used to treat breast cancer and osteoporosis so it's a great option for women who want to take HRT but have a history of breast cancer.

It's only suitable for women who are post menopause and on a low dose of oestrogen.   I don't know what the effects would be if you took a higher dose of both bazedoxifene and oestrogen but it would be expensive.

I think specialists are less worried about the BC risk with HRT now.   They have established that the risk (albeit a very small risk) is associated with the synthetic progesterone component of HRT which is why many women now use body identical progesterone.   I think there is also some risk associated with conjugates oestrogen. 

[MegnB]

My gyn just suggestions Duavee after I ditched HRT bc of that devli, progesterone (6 different formulations, hated all of them).
I'm interested in hearing other people's experiences. Gyn says it protects bones and manages most menopause symptoms well.

Thank you!

[Hurdity]

cityrat - yes it was me that mentioned Conbriza - did you contact Pfizer like I suggested?

Re dosage - I did read a paper on this when the Duavee/Duavive was relesaed to the market. It is dose dependent - the dosage of equine oestrogens (CEE) and the bazedoxifene was worked out to be that which produced no breakthrough bleeding. I can't remember all the details now but getting the dosage right was critical for bleed control and I presume for endometrial protection (in that breakthrough bleeding coudl indicate endometrial thickening). Higher oestrogen doses did cause more bleeding, I think even with a correspondingly higher dose of SERM - but I really can't recall all the details - sorry! If you want me to find the paper I'm sure I can...

From what I recall the trials used at least 4 different combos (maybe more?) - two different oestrogen doses and at least two different SERM doses.

It has been marketed separately by Pfizer under thre name "Viviant" but only I think in Japan and Korea ( quick look round the web) , but not approved by FDA in US - the process was initiated but doesn't look as though it was approved in US.

Hurdity x