Meta-analysis Of The Efficacy And Safety Of Dienogest In The Treatment Of Endometriosis

Objective: To systematically evaluate the efficacy and adverse reactions of denoprogesterone in the treatment of endometriosis.Methods: We used Wanfang Database,CNKI Database,VIP Database,PubMed,The Web of Science and The Cochrane Library to search all prospective randomized controlled studies of dienogest in the treatment of endometriosis from self-established databases up to March 2021.Relevant literatures were included in accordance with the inclusion criteria and exclusion criteria,and extract effective data.Rev Man 5.3software was used for statistical analysis.Patients for endometriosis receiving dienogest was called DNG group,while those receiving GnRH-a was called GnRH-a group,and those receiving placebo group is called placebo group.Results: After screening,seven articles were included,and the total number of patients with endometriosis was 1427.There were no statistical significance in the reduction of pelvic pain score(VAS)between DNG group and GnRH-a group[WMD=-1.27,95%CI(-3.64,1.10),P=0.29].the decrease of the percentage of lumbar bone density in DNG group was lower than that in GnRH-a group,and the difference was statistically significant [WMD=2.77,95%CI(0.16,5.39),P=0.04].The incidence of hot flashes and vaginal dryness in DNG group was lower than that in GnRH-a group,and the difference was statistically significant[OR=0.05,95%CI(0.02,0.10),P <0.001;OR=0.20,95%CI(0.08,0.48),P<0.001].The incidence of headache in DNG group was lower than that in GnRH-a group,and the difference was statistically significant[OR=0.66,95%CI(0.46,0.93),P=0.02].The incidence of weight gain was no significant difference between DNG group and GnRH-a group[OR=0.82,95%CI(0.21,3.15),P=0.77].The incidence of vaginal bleeding in DNG group was higher than that in GnRH-a group,and the difference was statistically significant[OR=6.52,95%CI(4.35,9.77),P<0.001].There were no significant difference in the duration and frequency of vaginal bleeding during the first 84 days of observation between the DNG group and the placebo group [WMD= 4.45,95%CI(4.07,12.98),P=0.31;WMD=-0.51,95%CI(-1.10,0.08),P=0.09].The recurrence rate of DNG group was significantly lower than that of GnRH-a group,and the difference was not statistically significant(P>0.05).Conclusion: Dienogest is as effective as GnRH-a in the treatment of endometriosis in improving pelvic pain,which was superior to placebo.Dienogest has little effect on the bone density of lumbar vertebra and is lower than GnRH-a.The incidence of hot flashes,vaginal dryness and headache is lower than GnRH-a.The incidence of recurrence and weight gain was similar to that of GnRH-a treatment.And DNG has good efficacy and safety.