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

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. K E Y W O R D Sendometriosis, gonadotropin-releasing hormone, network meta-analysis, pain score, progesterone

A single‐blind, randomized, pilot study of a brief mindfulness‐based intervention for the endometriosis‐related pain management

“…The present study demonstrates that MBI can also modulate endometriosis symptoms and could be integrated into standard medical care. This is particularly important to the endometriosis field because there is a lack of studies assessing non‐drug interventions (Chen et al, 2019), and women suffering from frequent symptoms, despite multiple treatments in tertiary care (De Graaff et al, 2013). The improvement in pain in our group of patients who do not respond to standard medical care highlights the importance of addressing psychological factors when treating endometriosis symptoms.…”

Comparação entre contraceptivos hormonais combinados e progestágenos isolados na efetividade do tratamento da endometriose: uma revisão de literatura / Comparison between combined hormonal contraceptives and progestogens in the effectiveness of the treatment of endometriosis: a literature review

“…Diante disso, esses medicamentos devem ser utilizados pelo período máximo de 6 meses. (SAUVAN M, et al, 2018;CHEN Y, et al, 2019;PODGAEC S, et al, 2020).…”

“…Porém há estudos controversos sobre sua eficácia em relação à dor pélvica em pacientes submetidas à laparoscopia previamente. (CHEN, et al,2019) Além disso, vê-se vários estudos abordando o uso de dispositivos e pílulas de progestágenos isolados, tais como o dispositivo uterino SIU-LNG (SIU-LNG) e dienogeste (DNG) por exemplo. Esses medicamentos agem através da intervenção no eixo neuroendócrino, interferindo no mecanismo de estimulação ovariana pelas gonadotrofinas, intervindo diretamente no mecanismo de feedback.…”

Robotic surgery for deep-infiltrating endometriosis: is it time to take a step forward?

“…Nonetheless, very few studies that compared the two minimally invasive approaches in patients with r-ASRM stage III/IV endometriosis are available. To the best of our knowledge, there are only one randomized-controlled trial (RCT) ( 33 ) and two meta-analyses ( 34 , 35 ) in that regard.…”