Medical therapy options for endometriosis related pain, which is better? A systematic review and network meta-analysis of randomized controlled trials

Ahmed Samy, Ayman Taher, Taher A, Sileem SA, Sileem A. Sileem, Abdelhakim AM, Ahmed Mohamed Abdelhakim, Mohamed Fathi, Hisham Haggag, Khaled Ashour, Ashour K, Shady Abdelsattar Ahmed, Ahmed SA, Mohammad Abrar Shareef, Shareef MA, Abdulhadi A. AlAmodi, AlAmodi AA, Nawal Hamdy Ahmed Keshta, Keshta NHA, Hanan Barakat Abu Elyazid Shatat, Shatat HBAE, Salah DM, Doaa M. Salah, Ahmed Ali, Ali AS, Ahmed Said Ali, El Kattan EAM, Eman Abdel Monem El Kattan, Elsherbini M, Moutaz Elsherbini
Journal of gynecology obstetrics and human reproduction · 2020 · vol. 50(1) , pp. 101798 · doi:10.1016/j.jogoh.2020.101798 · PMID:32479894 · W3031205009
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This systematic review and network meta-analysis compared the effectiveness of various medical therapies for endometriosis-related pain.

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Abstract

Our objective was to assess and rank different pharmacological interventions for relieving endometriosis-related pain. We conducted an online bibliographic search in different databases from their inception until March 2019. We included randomized controlled trials (RCTs) that assessed different medical therapies in the management of endometriosis-related pain. We applied this network meta-analysis (NMA) based on the frequentist approach using statistical package "netmeta" (version 1.0-1) in R software. Our main outcomes were the change in severity of pelvic pain, dysmenorrhea score, non-menstrual pelvic pain score, and dyspareunia score. Overall, 36 RCTs were included in this study (patients no. = 7942). Dienogest (0.94), combined hormonal contraceptives (CHCs) (0.782), and elagolix (0.38) were the highest-ranked interventions for reducing the severity of pelvic pain at three months, while at six months, gonadotropin-releasing hormone (GnRH) analogues (0.75), levonorgestrel-releasing intrauterine system (LNG-IUS) (0.73), and dienogest (0.65) were linked to more reduction in pelvic pain. The ranking p-score showed that GnRH analogues was the highest-ranked treatment for reducing dysmenorrhea at 3 months (1.00), while CHCs were the highest-ranked treatment at 6 months (0.97), followed by GnRH analogues (0.89). GnRH analogues (0.63) and elagolix (0.54) at three months while desogestrel (0.94) and CHCs (0.91) at six months were the highest-ranked treatment to reduce non-menstrual pelvic pain. GnRH analogues and elagolix were the highest-ranked pharmacologic therapies for reducing dyspareunia. In conclusion, CHCs, GnRH analogues, progesterone, and elagolix were the best approaches in reducing the pain of endometriosis.

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Condition tags

dysmenorrheaendometriosischronic_pelvic_pain

MeSH descriptors

Dysmenorrhea Endometriosis Pelvic Pain Contraceptive Agents, Hormonal Contraceptive Agents, Hormonal Contraceptives, Oral, Hormonal Contraceptives, Oral, Hormonal Dysmenorrhea Dysmenorrhea Endometriosis Female Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Humans Hydrocarbons, Fluorinated Hydrocarbons, Fluorinated Levonorgestrel Levonorgestrel Nandrolone Nandrolone

Citation neighborhood

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. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (79)

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