Gonadotrophin Releasing Hormone Agonist For Endometriosis After Conservative Surgery: A Meta-analysis

Background:Various options exist for treating endometriosis. Surgical treatment is effective, but some patients experience pain again or the disease recurs within 1 or 2 year. So postoperative treatment with gonadotrophin releasing hormone agonists (GnRHa) has been suggested. Some randomized controlled trials (RCTs) have been published assessing its effectiveness, however, data available of the outcomes was noncoincidence. Therefore, it is necessary to carry out a meta-analysis of the evidence on outcomes for postoperative GnRHa in patients with endometriosis.Objectives:To evaluate the effectiveness of postoperative GnRHa in patient with endometriosis by means of a meta-analysis.Methods:A fully recursive literature search was conducted in the Cochrane Controlled Trials Register Databases, PubMed, Embase, ISI databases, Chinese Biomedical Literature Database, CNKI and Chinese VIP Database from their inception to May 2009 in any language. Statistic analyses were carried out using RevMan software. Selection criteria:Randomised controlled trials (RCTs) that compared postoperative GnRHa treatment with no treatment, placebo or progestins for endometriosis was selected. Data collection and analysis:Two reviewers independently extracted the data and analyzed them in the RevMan Manager 5.0 software.Main results:Eighteen RCTs including 1716 patients were included. There was a significantly higher rate of total remission of disease in GnRHa compared with control group [OR=3.12,95% CI(1.66-5.84)]. Postoperative GnRHa treatment could not increase the pregnancy rate of infertility associated with endometriosis:[at 1 year subgroup:OR=1.76,95% CI(0.85-3.62); at 2 year subgroup:OR=0.95,95% CI (0.36-2.49); at 5 year subgroup:OR=0.65,95% CI (0.14-3.04)]. Despite the 1 year's recurrence of painful symptoms was statistically lower, there was no difference in 2 and 5 year's [OR=0.49,95% CI (0.31-0.77); at 2 year subgroup:OR=0.67,95% CI (0.43-1.03); at 5 year subgroup:OR=0.88; 95% CI (0.30-2.57)]. There is no statistical difference between GnRHa and progestins group on all outcome measures.Conclusions:Postoperative GnRHa for endometriosis can effectively reduce the recurrence of pain within 1 year of treatment and improve the total remission rate of diseases, which has no advantage on pregnancy rate, disease and recurrence of painful symptoms of 2 year later. And it is no benefit on pregnancy rate, disease and recurrence of painful symptoms compared with progestins. There is a need for further well-designed powered RCTs of this approach.