Published online Aug 28, 2021. doi: 10.13105/wjma.v9.i4.377
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
Endometriosis is one of the common gynecological diseases in reproductive women and the concomitant pelvic pain has substantial negative effects on patients’ quality of life. In recent years, significant advances have been made in the treatment of endometriosis, and drugs remain the primary treatment option for women of childbearing age. However, there is no agreement on which drugs are most effective and tolerated for the treatment of endometriosis.
Several well-designed randomized controlled trials (RCTs) have demonstrated that dienogest is effective in relieving endometriosis-related pain and has a tolerable adverse-effect profile. However, these RCTs have not unambiguously demonstrated whether dienogest is superior to other drugs.
This study was conducted to evaluate the effectiveness and safety of dienogest compared with other drugs for the treatment of endometriosis.
This meta-analysis only included RCTs that compared dienogest with other drugs in the treatment of endometriosis. Review Manager (RevMan) 5.3 software was used to calculate mean difference (MD) values and risk ratios (RRs) with 95% confidence intervals (CIs).
This study included seven RCTs with 1493 participants and demonstrated that dienogest was more effective than placebo in alleviating endometriosis-related pain (MD = -32.93, 95%CI: -44.63 to -21.23), and led to a more significant decrease in plasma estradiol concentrations than placebo (MD = -44.7, 95%CI: -62.24 to -24.69). The combined results showed that dienogest was superior to GnRH-a in relieving pain (MD = -2.41, 95%CI: -3.58 to -1.24). Furthermore, adverse events were more frequent in patients in the GnRH-a group, including the loss of BMD (MD = 2.77, 95%CI: 0.16 to 5.37), headaches (RR = 0.68, 95%CI: 0.52 to 0.91), and hot flushes (RR = 0.43, 95%CI: 0.18 to 1.02).
Dienogest is an effective and tolerable therapeutic for the treatment of endometriosis-related pain in women of reproductive age.
The results of this meta-analysis provide insights on how the clinical use of medications for endometriosis could be standardized and should improve the choice of medications for patients.