Efficacy of ten interventions for endometriosis: A network meta-analysis

Chen Y, Yan Chen, Hua Wang, Wang H, Wang S, Saili Wang, Xinying Shi, Shi X, Wang Q, Qin Wang, Ren Qing-ling
Journal of cellular biochemistry · 2019 · vol. 120(8) , pp. 13076–13084 · doi:10.1002/jcb.28579 · PMID:30937963 · W2930163475
Systematic review / meta-analysis OA: closed CC0 ⤵ 9 in-corpus citations
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Expectant management, progesterone, and GnRH-agonists effectively reduced endometriosis pain compared to placebo, with expectant management ranking highest, while no significant differences in pregnancy rates were found between interventions.

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Abstract

OBJECTIVE: Clinical trials comparing the efficacy of different interventions for endometriosis are limited and controversial. The aim of the present study is to perform a network meta-analysis on the efficacy of various interventions for endometriosis. METHODS: We searched PubMed and Ovid EMBASE through 1 June, 2018, for trials reporting the pain score and 1-year pregnancy rate of patients including at least one pair of direct control group. The mean difference of pain score, odds ratio of 1-year pregnancy rate, and their associated 95% credible intervals (CrI) were used to describe efficacy. The surface under the cumulative ranking curve (SUCRA) was calculated to illustrate the rank probability of various treatments for different outcomes, on the basis of network meta-analysis. RESULTS: Our meta-analysis enrolled six studies for the evaluation of reducing pain and 10 studies for the 1-year pregnancy rate. All involved trials were sufficiently powered with a low risk of bias. Expectant management (EM), progesterone (PR), and gonadotropin-releasing hormone (GnRH)-agonist (GN) were significantly effective to reduce pain when compared with the placebo; EM ranked the highest on the SUCRA curve. For the 1-year pregnancy rate, no significant difference between the interventions was evident. Ablation ranked the highest with a SUCRA value of 0.6328. The rank of EM was acceptable with a SUCRA value of 0.4452. Our experimental results need to be verified by more high-quality randomized controlled trial articles. CONCLUSION: Limited available evidence showed that EM, PR, and GN were significantly effective to reduce pain when compared with the placebo. Due to a lack of convincing evidence favoring surgery or medication, we recommend considering EM.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Gonadotropin-Releasing Hormone Pain Progesterone Watchful Waiting Endometriosis Endometriosis Endometriosis Female Female Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Humans Humans Pain Pain Pain Pregnancy Pregnancy Pregnancy Rate

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (36)

Cited by (9)

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