Dienogest versus gonadotropin-releasing hormone analogues for the clinical treatment of endometriosis: an updated meta-analysis

Kanwal Majeed, Zainab Muhammad Hanif, Muzna Murtaza, Hassam Ali, Atiya Batool, Hina Syed
In: International Journal of Scientific Reports · 2024 · vol. 10(12) , pp. 432–441 · doi:10.18203/issn.2454-2156.intjscirep20243494 · W4404679202
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This meta-analysis of eight RCTs found dienogest and GnRH analogues equally effective for endometriosis pain but dienogest showed lower recurrence, fewer hot flushes, and preserved bone density, despite a higher risk of irregular bleeding.

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This updated systematic review and meta-analysis compared dienogest with gonadotropin-releasing hormone (GnRH) analogues in women with endometriosis, using randomized controlled trials identified from PubMed, Google Scholar, and Cochrane Library searches through August 2024 and pooled with a random-effects model. Eight RCTs totaling 1,219 participants (602 on dienogest and 617 on GnRH analogues) found both treatments were similarly effective for controlling pain, dysmenorrhea, and dyspareunia, while dienogest showed advantages including lower recurrence rates and reduced hot flushes and protection against bone mineral density loss; however, irregular vaginal bleeding was more frequent with dienogest, and headache/vaginal dryness/spotting/alopecia were not statistically significant. The analysis is limited by its reliance on included RCTs, with the paper providing outcomes across trials rather than addressing every adverse effect equally. This paper is centrally about endometriosis — it is an updated meta-analysis of dienogest versus GnRH analogues for clinical treatment of endometriosis.

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Abstract

Endometriosis is a chronic gynecological condition where endometrial-like tissue grows outside the uterus, leading to persistent pelvic pain, dysmenorrhea, dyspareunia, and infertility. The objective of the systematic review was to examine the efficacy and safety of Dienogest, which is a synthetic, orally active 19-nortestosterone derivative, in the treatment of women with endometriosis compared to GnRH-a, which is commonly used to treat conditions like endometriosis. We conducted a search of PubMed, Google Scholar, and Cochrane Library databases from inception until August 2024 for clinical studies, using the following keywords: ("Dienogest") and ("gonadotropin-releasing hormone analogue" or GnRH Analogues OR GnRH agonist) and (Endometriosis). Relevant randomized control trials were identified. Pooled effect estimates were calculated using a random effect model. This meta-analysis included eight randomized controlled trials (RCTs) with 1,219 patients, 602 in the dienogest group and 617 in the GnRH analogue group. Both treatments were equally effective in controlling pain, dysmenorrhea, and dyspareunia, but dienogest offered advantages. Dienogest significantly reduced the recurrence rate (RR: 0.37, 95% CI [0.15, 0.91]; p=0.03) and hot flushes (RR: 0.24, 95% CI [0.10, 0.59]; p=0.002) and protected against bone mineral density (BMD) loss. However, it increased the risk of irregular vaginal bleeding (RR: 3.61, 95% CI [1.09, 11.97]; p=0.04). Other side effects, such as headache, vaginal dryness, spotting, and alopecia, were not statistically significant. It concluded that Dienogest has comparatively fewer side effects than GnRH analogue, making it a considerably safer option for treating endometriosis.
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Dienogest versus gonadotropin-releasing hormone analogues for the clinical treatment of endometriosis: an updated meta-analysis DOI: https://doi.org/10.18203/issn.2454-2156.IntJSciRep20243494Keywords: Dienogest, GnRH analogue, GnRH agonist and endometriosisAbstract Endometriosis is a chronic gynecological condition where endometrial-like tissue grows outside the uterus, leading to persistent pelvic pain, dysmenorrhea, dyspareunia, and infertility. The objective of the systematic review was to examine the efficacy and safety of Dienogest, which is a synthetic, orally active 19-nortestosterone derivative, in the treatment of women with endometriosis compared to GnRH-a, which is commonly used to treat conditions like endometriosis. We conducted a search of PubMed, Google Scholar, and Cochrane Library databases from inception until August 2024 for clinical studies, using the following keywords: ("Dienogest") and ("gonadotropin-releasing hormone analogue" or GnRH Analogues OR GnRH agonist) and (Endometriosis). Relevant randomized control trials were identified. Pooled effect estimates were calculated using a random effect model. This meta-analysis included eight randomized controlled trials (RCTs) with 1,219 patients, 602 in the dienogest group and 617 in the GnRH analogue group. Both treatments were equally effective in controlling pain, dysmenorrhea, and dyspareunia, but dienogest offered advantages. Dienogest significantly reduced the recurrence rate (RR: 0.37, 95% CI [0.15, 0.91]; p=0.03) and hot flushes (RR: 0.24, 95% CI [0.10, 0.59]; p=0.002) and protected against bone mineral density (BMD) loss. However, it increased the risk of irregular vaginal bleeding (RR: 3.61, 95% CI [1.09, 11.97]; p=0.04). 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