A Systematic Review For Mifepristone In Post Operative Medical Therapy For Endometriosis

Objective:To evaluate the effectiveness of postoperative gestrinone in patient with endometriosis by means of a meta-analysis.Methods: A full recursive literature search was conducted in the cochrane controlled trials register databases,Pubmed,Embase,CBMdisc,CNKI and VIP ,WANFANG DATABASE from their inception to december 2010. Relevant journals were also hand searched. We collected randomized controlled trials(RCT) of gestrinone in postoperative medical therapy for endometriosis . Two reviewers independently extracted the data and analyzed them in Revman Manager software.Results: 16 RCTs involving 1329 eligible patients were included.6 trials compared gestrinone with mifepristone .1 trial compared post-operative adjuvant gestrinone treatment of endometriosis with surgery alone. 5 trials compared gestrinone with GnRH-a. 2 trials compared gestrinone with oral contraceptives. 2 trials compared gestrinone with danazol.The meta-analyses showed that : (1)Complete remission: post-operative adjuvant gestrinone treatment of endometriosis compared to surgery alone showed benefit for complete remission of disease;there was a significantly higher rate of complete remission of disease in GnRH-a compared with gestrinone;and no statistical difference among gestrinonne and mifepristone, oral contraceptives, danazol. (2)The pregnancy rate at the end of follow-up : compared to surgery alone,post-operative gestrinone treatment of endometriosis showed benefit for pregnancy rate. and there is no statistical difference between gestrinone and other drugs. (3)The recurrence of painful symptoms at the end of follow-up: post-operative adjuvant gestrinone treatment of endometriosis compared to surgery alone showed benefit for reducing the recurrence of painful symptoms. There was a significantly higher rate of reducing the recurrence of painful symptoms in GnRH-a compared with gestrinone;and no statistical difference among gestrinone and mifepristone, oral contraceptives, danazol. (4)The main side effects after gestrinone treatment was liver damage, weight gain, increased body hair, acne, voice changes, irregular vaginal bleeding.Conclutions: The limited evidence suggests that postoprative gestrinone for endometriosis can improve the complete remission rate of disease,pregnancy rate and reduce the pain recurrence rate;compared with GnRH-a ,there was a significantly higher rate of total remission of disease and reducing the recurrence of painful symptoms,but no statistical difference in pregnancy rate.And there is no statistical difference between gestrinone and other medical treatment(mifepristone, oral contraceptives, danazol) on all outcome messures.