Efficacy And Safety Of Different Subsequent Therapies After Fertility Preserving Surgery For Endometriosis:A Network Meta-analysis

ObjectiveTo evaluate the efficacy and safety of dienogest,deuprolide,danazol,gestrinone,mifepristone and LNG-IUS in relieving the symptoms and delaying the recurrence of endometriosis cysts after fertility preserving surgery for endometriosis.MethodsWe searched PubMed,the Cochrane Library,Web of Science,EMBase,CNKI,VIP,CBM,WanFang Data databases to collect randomized controlled trials(RCT)related to dienogest,leuprolide,danazol,gestrinone,mifepristone and LNG-IUS As a follow-up treatment after fertility preserving surgery for endometriosis(The retrieval period is from November 2019).EndNote X8 software was used for the screening of included studies,and two researchers independently screened the literature,obtained data and evaluated the literature quality.Data analysis was carried out by STATA 15.0 software.Eefficacy and safety were measured by efficience rate,recurrence rate,pregnancy rate and adverse reaction rate.We have draw the evidence network,assessed the publication bias,and tested inconsistencies.The drug which is most likely to be the best postoperative treatment was explored by comparing the combinations of different interventions and ranking the best outcome indicators.Result(1)Considering of the effective rate after fertility preserving surgery of EMT,dienogest,leuprolide,danazol and LNG-IUS were better than placebo.Dienogest is higher than mifepristone and danazol.The effective rate of LNG-IUS is better than danazol.There is no difference between the other interventions.The effective rate rank is LNG-IUS,dienogest,leuprolide,gestrinone,mifepristone,danazol and placebo.(2)Considering of the recurrence rate after fertility preserving surgery of EMT,dienogest,leuprolide,gestrinone,mifepristone and LNG-IUS were lower than placebo.The recurrence rate of dienogest,LNG-IUS is lower than danazol.There is no difference between the other interventions.The recurrence rate rank is placebo,danazol,gestrinone,mifepristone,leuprolide,LNG-IUS and dienogest(3)Considering of the pregnancy rate of after fertility preserving surgery of EMT,dienogest and leuprolide were higher than placebo.The pregnancy rate of dienogest is higher than danazol and gestrinone.There is no difference between the other interventions.The pregnancy rate rank is dienogest,leuprolide,gestrinone,mifepristone,danazol and placebo.(4)Considering of the adverse reactions rate after fertility preserving surgery of EMT,dienogest,leuprolide,danazol,gestrinone,mifepristone and LNG-IUS were higher than placebo.There is no difference between other interventions.Except placebo,the adverse reactions rate rank is danazol,leuprolide,gestrinone,mifepristone,dienogest and LNG-IUS.ConclusionFor patients after fertility preserving surgery for endometriosis,dienogest and LNG-IUS are more effective than other 5 interventions in relieving the symptoms and delaying the recurrence of endometriosis,and have better safety.For patients with postoperative fertility requirements,the pregnancy rate of dienogest was better than other 6 interventions.