A Systematic Review For Mifepristone In Pre And Post Operative Medical Therapy For Endometriosis Surgery

Objectives:To assess the effectiveness of mifepristone in pre and post operative medical therapy for endometriosis surgery,Methods:The Cochrane systematic review method was used to evaluate the Randomized Controlled Trials(RCTs)of mifepristone in pre and post operative medical therapy for endometriosis surgery.The searching strategy included: MEDLINE(1950 to 12.2006),EMBASE(1980 to 12.2006),The Cochrane Central Register of Controlled Trials(Issue 4,2006),Current Controlled Trials,The National Research Register,Clinical Trials,CBM(1978-2006.12), VIP(1989-2006.12),CNKI(1996-2006.12).We also handsearched some related journals.The search was conducted in 12.2006.Three reviewers evaluated quality of studies,meta-analysis were performed for combine the results of homogeneity studies.The RevMan 4.2.8 software was used for statistical analysis.Results:We identified 6 studies including 667 patients.All included studies were mifepristone used post conservative surgery(surgery which conserve the pelvic organs)for endometriosis,of which 3 studies compared mifepristone used post surgery to surgery alone(no medical therapy)and 5 studies compared mifepristone used post surgery to other medical hormonal suppression therapies used post surgery.Exclude 1 study had descripted the randomization,all the other included studies were inadquate in reporting randomization,concealment of allocation and blinding.Meta-analysis based on included studies showed that there were no significant difference between mifepristone and other hormonal suppression(danazol,gestrinone or GnRH-a)used post surgery for the outcomes of pain,pregnancy rates or disease recurrence but a significant improvement in adverse effects.Mifepristone used post surgery of endometriosis compared to surgery alone including 2 subgroups.1 subgroups(12.5mg/d,6 months)showed that there was a significant improvement in the outcomes of pain,pregnancy rates or disease recurrence in the mifepristone therapy group.But another subgroup(12.5mg/d,3 months)did not show that the mifepristone therapy post surgery for endometriosis is associated with a significant benefit with regard to any of the outcomes identified.Conclusions:The limited evidence showed that there were no significant difference between mifepristone and other hormonal suppression(danazol, gestrinone or GnRH-a)used post surgery for the outcomes of pain,pregnancy rates or disease recurrence but a significant improvement in adverse effects. Mifepristone used post surgery of endometriosis may superior to surgery alone, but the results in different subgroups were inconsistency.Our results suggest that further and larger scale trials of the use of mifepristone in pre and post operative medical therapy for endometriosis surgery are needed.