Systematic review and Meta-analysis of efficacy and safety of dienogest in treatment of endometriosis

BACKGROUND The quality of life of women with endometriosis is substantially adversely affected by the pelvic pain caused by this disease. However, the choice of medication for endometriosis remains controversial, and no drug has been clearly proven to be superior to others.AIM To assess the efficacy and safety of dienogest, a synthetic progestin, in the treatment of women with painful symptoms of endometriosis.METHODS Pub Med, EMBASE, the Cochrane Library, and the Web of Science databases were searched from their inceptions to January 21, 2020 for randomized controlled trials(RCTs) that compared dienogest with other popular prescription drugs for the treatment of endometriosis. Two reviewers extracted the data. Mean difference(MD) values and risk ratios(RRs) with 95% confidence intervals(CIs) were calculated.RESULTS Ultimately, seven RCTs with a total of 1493 participants met the requirements for this review. Dienogest was found to more effective than placebo in alleviating endometriosis-related pain(MD =-32.93, 95%CI:-44.63 to-21.23), but led to a more significant decline in plasma estradiol concentrations than placebo(MD =-44.7, 95%CI:-62.24 to-24.69). Dienogest was superior to gonadotropin-releasing hormone analogues(Gn RH-a) in relieving pain(MD =-2.41, 95%CI:-3.58 to-1.24). Moreover, compared with dienogest, Gn RH-a were significantly more likely to lead to the loss of bone mineral density(MD = 2.77, 95%CI: 0.16 to 5.37) and were significantly associated with a higher incidence of headaches(RR = 0.68, 95%CI: 0.52 to 0.91) and hot flushes(RR = 0.43, 95%CI: 0.18 to 1.02).CONCLUSION This meta-analysis demonstrated that dienogest may be a better pain-relief treatment for endometriosis patients, due to its high efficacy and tolerability.