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:
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.
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
Research background

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.

Research motivation

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.

Research objectives

This study was conducted to evaluate the effectiveness and safety of dienogest compared with other drugs for the treatment of endometriosis.

Research methods

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).

Research results

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).

Research conclusions

Dienogest is an effective and tolerable therapeutic for the treatment of endometriosis-related pain in women of reproductive age.

Research perspectives

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.