Efficacy And Safety Of Dienogest Versus Gonadotropin-releasing Hormone Agonists In The Treatment Of Endometriosis:a Meta-analysis

ObjectivesEndometriosis is a common and frequently-occurring disease in reproductive women.Dienogest and Gonadotropin-Releasing Hormone agonist are commonly used in the treatment of endometriosis.This paper aims to summarize the clinical efficacy and safety analysis of domestic and foreign multicenter prospective randomized controlled trials comparing Dienogest and Gonadotropin-Releasing Hormone agonist and evaluate the efficacy and safety of Dienogest and Gonadotropin-Releasing Hormone agonist in the treatment of endometriosis systematically,so as to provide higher-level evidence-based medicine to guide clinical practice.MethodsIn this study,a comprehensive search of electronic information databases(including Pub Med,Embase,Web of Science,the Cochrane)was conducted.In order to find the randomized controlled trials of Dienogest versus Gonadotropin-Releasing Hormone agonist in the treatment of endometriosis,the literature was selected in strict accordance with the inclusion and exclusion criteria.After the independent strict screening,data extraction,and quality evaluation,two reviewers applied the Review Manager 5.3 software for meta-analysis.ResultsThe search time was from the database establishment to November 2020.After full search and strict screening,a total of 6 Randomized Controlled Trials were included.The research quality was high and the risk of bias was low.A total of 982 patients met the revised 1985 American reproductive society staging I-IV criteria.There was no significant difference in age,weight,and general clinical data.Meta-analysis showed that: in terms of pain relief,the VAS score of Dienogest was1.62 points lower than that of Gonadotropin-Releasing Hormone agonist(95%CI:0.59～2.65,P=0.002),and the difference had no significant clinical significance,suggesting that Dienogest and Gonadotropin-Releasing Hormone agonist had the same effect on pain relief.The results showed that Dienogest has the same effec in reducing the recurrence rate,the volume of the chocolate cyst,and the size of endometriosis lesions.Dienogest has higher estradiol level(MD:-17.82,95% CI:-30.85-4.78,P = 0.007),more vaginal bleeding side effects(or =4.47,95% CI: 3.24-6.17,P < 0.001)and more weight gain(OR: 2.54,95% CI:1.14-5.66,P = 0.02)than Gn RH agonist.Compared with Gonadotropin-Releasing Hormone agonist,Dienogest has lower side effects of hot flashes(OR = 0.10,95%CI: 0.03-0.34,P < 0.001),headache(OR: 0.66,95% CI: 0.46-0.93,P = 0.02)and bone loss.ConclusionsCompared with Gonadotropin Releasing Hormone Agonist,Dienogest has the same effect in relieving pain and reducing recurrence.But Dienogest has higher estradiol level,more vaginal bleeding、weight gain side effects,less hot flashes,headache,bone loss side effects,which is suitable for clinical promotion.