Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Aug 28, 2021; 9(4): 377-388
Published online Aug 28, 2021. doi: 10.13105/wjma.v9.i4.377
Systematic review and Meta-analysis of efficacy and safety of dienogest in treatment of endometriosis
Shao-Chong Lin, Xin-Yue Wang, Xi-Ling Fu, Wen-Hui Yang, Han Wu, Yang Bai, Zhong-Na Shi, Jun-Peng Du, Bao-Jin Wang
Shao-Chong Lin, Xin-Yue Wang, Xi-Ling Fu, Yang Bai, Zhong-Na Shi, Bao-Jin Wang, Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Wen-Hui Yang, Pharmacy Department, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Han Wu, Medical School of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Jun-Peng Du, Department of Pediatric Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Author contributions: Lin SC, Wang BJ, and Du JP conceived and designed the study; Wang XY and Fu XL researched, extracted, and evaluated the data; Yang WH, Wu H, and Bai Y performed data analyses; Lin SC and Shi ZN wrote the manuscript; all authors read and approved the final manuscript.
Supported by the Science and Technology Department of Henan Province, No. 132300410352.
Conflict-of-interest statement: The authors deny any conflict of interest for this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bao-Jin Wang, PhD, Doctor, Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfu Front Street, Erqi District, Zhengzhou 450052, Henan Province, China. 2995269936@qq.com
Received: June 16, 2021
Peer-review started: June 16, 2021
First decision: July 6, 2021
Revised: July 17, 2021
Accepted: August 20, 2021
Article in press: August 20, 2021
Published online: August 28, 2021
Abstract
BACKGROUND

The quality of life of women with endometriosis is substantially adversely affected by the pelvic pain caused by this disease. However, the choice of medication for endometriosis remains controversial, and no drug has been clearly proven to be superior to others.

AIM

To assess the efficacy and safety of dienogest, a synthetic progestin, in the treatment of women with painful symptoms of endometriosis.

METHODS

PubMed, EMBASE, the Cochrane Library, and the Web of Science databases were searched from their inceptions to January 21, 2020 for randomized controlled trials (RCTs) that compared dienogest with other popular prescription drugs for the treatment of endometriosis. Two reviewers extracted the data. Mean difference (MD) values and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.

RESULTS

Ultimately, seven RCTs with a total of 1493 participants met the requirements for this review. Dienogest was found to more effective than placebo in alleviating endometriosis-related pain (MD = -32.93, 95%CI: -44.63 to -21.23), but led to a more significant decline in plasma estradiol concentrations than placebo (MD = -44.7, 95%CI: -62.24 to -24.69). Dienogest was superior to gonadotropin-releasing hormone analogues (GnRH-a) in relieving pain (MD = -2.41, 95%CI: -3.58 to -1.24). Moreover, compared with dienogest, GnRH-a were significantly more likely to lead to the loss of bone mineral density (MD = 2.77, 95%CI: 0.16 to 5.37) and were significantly associated with a higher incidence of headaches (RR = 0.68, 95%CI: 0.52 to 0.91) and hot flushes (RR = 0.43, 95%CI: 0.18 to 1.02).

CONCLUSION

This meta-analysis demonstrated that dienogest may be a better pain-relief treatment for endometriosis patients, due to its high efficacy and tolerability.

Keywords: Dienogest, Gonadotrophin-releasing hormone analogues, Meta-analysis, Endometriosis, Medication

Core Tip: We comprehensively and systematically analyzed the safety and effectiveness of dienogest for the treatment of endometriosis-related pain. Only high-quality randomized controlled trials that compared dienogest with other drugs, such as gonadotrophin-releasing hormone analogues and placebo, were included in the meta-analysis. The results provide guidelines for the standardization of the clinical use of medications for endometriosis and would improve the choice of medications for patients.