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, Sileem A Sileem, Ahmed Mohamed Abdelhakim, Mohamed Fathi, Hisham Haggag, Khaled Ashour, Shady Abdelsattar Ahmed, Mohammad Abrar Shareef, Abdulhadi A AlAmodi, Nawal Hamdy Ahmed Keshta, Hanan Barakat Abu Elyazid Shatat, Doaa M Salah, Ahmed Said Ali, Eman Abdel Monem El Kattan, Moutaz Elsherbini

Journal: Journal of gynecology obstetrics and human reproduction 2021;50(1):101798

PMID: 32479894

Full Text on Elsevier Science View on PubMed

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.

Address: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.; Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University, Assiut, Egypt.; Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt. Electronic address: [email protected].; Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt.; Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt; Department of Obstetrics and Gynecology, University of Würzburg, Würzburg, Germany.; Faculty of Pharmacy, Cairo University, Cairo, Egypt.; President of Arab Society of Fetal Medicine, Cairo, Egypt.; Department of Internal Medicine, Sebasticook Valley Hospital, USA.; School of Public Health, College of Health Sciences Department of Epidemiology and Biostatistics, Jackson State University, Jackson, MS, USA.; Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University, Girls Branch, Cairo, Egypt.; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

DOI: 10.1016/j.jogoh.2020.101798

Link outs

Free resources

Medical:

https://medlineplus.gov/periodpain.html

Other Literature Sources:

https://scite.ai/reports/32479894

Subscription / membership required

Full Text Sources:

MeSH Terms: Contraceptive Agents, Hormonal, Contraceptives, Oral, Hormonal, Dysmenorrhea, Endometriosis, Female, Gonadotropin-Releasing Hormone, Humans, Hydrocarbons, Fluorinated, Levonorgestrel, Nandrolone, Pelvic Pain, Pyrimidines, Randomized Controlled Trials as Topic, Visual Analog Scale