[Systematic Review / Meta-analysis]
Dienogest And The Risk Of Endometriosis Recurrence Following Surgery: A Systematic Review And Meta-Analysis.
Zakhari A et al.
Journal of Minimally Invasive Gynecology. 2020 May 16;
https://doi.org/10.1016/j.jmig.2020.05.007PMID: 32428571STUDY OBJECTIVE: To determine whether dienogest therapy following endometriosis surgery reduces the risk of endometriosis recurrence compared to expectant management.
DATA SOURCES: Ovid MEDLINE, Ovid EMBASE, PubMed, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, clinicaltrials.gov and International Standard Randomized Controlled Trial Number Registry were searched from inception to March 2019 for observational and randomized controlled trials.
METHODS OF STUDY SELECTION: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. MeSH terms and keywords such as "dienogest", "endometriosis" and "recurrence" were used to identify relevant studies.
TABULATION, INTEGRATION, AND RESULTS: The search yielded 328 studies, 10 of which were eligible for inclusion, representing 1,184 patients treated with dienogest and 846 expectantly managed controls. Among these studies, 9 looked exclusively at endometrioma recurrence, whereas one used reappearance of symptoms as evidence of disease recurrence. Data on both incidence of and time to recurrence of endometriosis was extracted. The incidence rate of endometriosis recurrence in patients treated with dienogest was 2 per 100 women over a mean follow-up of 29 months (95% CI: 1.43 to 3.11) versus 29 per 100 women expectantly management, over a mean follow-up of 36 months (95% CI: 25.66 to 31.74). Likelihood of recurrence was significantly reduced with post-operative dienogest (log odds -1.96, CI: -2.53 to -1.38, p < 0.001).
CONCLUSION: Patients receiving dienogest after conservative surgery for endometriosis had significantly lower risk of post-operative disease recurrence compared to those expectantly managed.
Copyright © 2020. Published by Elsevier Inc.
DATA SOURCES: Ovid MEDLINE, Ovid EMBASE, PubMed, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, clinicaltrials.gov and International Standard Randomized Controlled Trial Number Registry were searched from inception to March 2019 for observational and randomized controlled trials.
METHODS OF STUDY SELECTION: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. MeSH terms and keywords such as "dienogest", "endometriosis" and "recurrence" were used to identify relevant studies.
TABULATION, INTEGRATION, AND RESULTS: The search yielded 328 studies, 10 of which were eligible for inclusion, representing 1,184 patients treated with dienogest and 846 expectantly managed controls. Among these studies, 9 looked exclusively at endometrioma recurrence, whereas one used reappearance of symptoms as evidence of disease recurrence. Data on both incidence of and time to recurrence of endometriosis was extracted. The incidence rate of endometriosis recurrence in patients treated with dienogest was 2 per 100 women over a mean follow-up of 29 months (95% CI: 1.43 to 3.11) versus 29 per 100 women expectantly management, over a mean follow-up of 36 months (95% CI: 25.66 to 31.74). Likelihood of recurrence was significantly reduced with post-operative dienogest (log odds -1.96, CI: -2.53 to -1.38, p < 0.001).
CONCLUSION: Patients receiving dienogest after conservative surgery for endometriosis had significantly lower risk of post-operative disease recurrence compared to those expectantly managed.
Copyright © 2020. Published by Elsevier Inc.
Affiliations
- 1 Mount Sinai Hospital, Department of Obstetrics and Gynecology, 600 University Avenue, Toronto ON, Canada, M5G 1 × 5
- 2 Mount Sinai Hospital, 600 University Avenue, Toronto ON, Canada, M5G 1 × 5
- 3 Biostatistics Research Unit, University Health Network (UHN), 200 Elizabeth Street, Toronto ON, Canada, M5G 2C4
- 4 Queen's University, Department of Obstetrics and Gynecology - Kingston General Hospital Victory 4, Kingston ON, Canada, K7L 2V7
- 5 Mount Sinai Hospital, Department of Obstetrics and Gynecology, 600 University Avenue, Toronto ON, Canada, M5G 1 × 5. ally.murji@sinaihealthsystem.ca
