Kou Liqiu, Huang Changyou, Xiao Di, Liao Songjie, Li Yaling, Wang Qing
Department of Pharmacy, Zigong Maternal and Child Health Care Hospital, Zigong, and the Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, and the School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China.
Obstet Gynecol. 2025 May 15;146(2):e23-e35. doi: 10.1097/AOG.0000000000005923.
To evaluate the effectiveness of various medications for the treatment of endometriosis-related pain through a network meta-analysis.
A comprehensive search was conducted in PubMed, Embase, Web of Science, and the Cochrane Controlled Trials Register until July 22, 2024. We also searched ClinicalTrials.gov for additional data on recently completed trials or potentially eligible randomized controlled trials (RCTs) but found nothing.
The analysis included randomized RCTs that used pharmacologic interventions for managing endometriosis-related pain. The primary efficacy outcome was endometriosis-associated pelvic pain, which included dysmenorrhea, dyspareunia, and nonmenstrual pelvic pain. The analysis adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines.
TABULATION, INTEGRATION, AND RESULTS: A total of 31 RCTs involving 8,665 patients were included in the analysis. In terms of endometriosis-associated pelvic pain, four interventions demonstrated significantly greater efficacy compared with placebo: leuprolide combined with combined oral contraceptive pills (OCPs) (standardized mean difference [SMD] -1.40, 95% CI, -2.41 to -0.38), dienogest (SMD -1.20, 95% CI, -1.78 to -0.61), leuprolide alone (SMD -1.05, 95% CI, -1.64 to -0.45), and combined OCP (SMD -0.67, 95% CI, -1.25 to -0.09). Leuprolide combined with combined OCP emerged as the most effective treatment modality. In addition, elagolix and the combination of vitamin C and vitamin E were identified as the most effective interventions for dysmenorrhea and dyspareunia. For nonmenstrual pelvic pain, gestrinone demonstrated superior efficacy compared with placebo and all other interventions.
This network meta-analysis indicates that leuprolide in combination with combined OCP, elagolix, vitamins C and E, and gestrinone may represent the most effective therapeutic options for alleviating endometriosis-associated pelvic pain, dysmenorrhea, dyspareunia, and nonmenstrual pelvic pain. These findings enhance our understanding of the relative efficacy of treatment strategies for pain associated with endometriosis. Future research should focus on conducting larger-scale and rigorously designed clinical trials within the target patient populations to further validate these results.
通过网状Meta分析评估各种药物治疗子宫内膜异位症相关疼痛的有效性。
截至2024年7月22日，在PubMed、Embase、Web of Science和Cochrane对照试验注册库中进行了全面检索。我们还在ClinicalTrials.gov上搜索了有关最近完成试验或潜在符合条件的随机对照试验（RCT）的更多数据，但未找到相关信息。
分析纳入了使用药物干预治疗子宫内膜异位症相关疼痛的随机RCT。主要疗效结局是子宫内膜异位症相关的盆腔疼痛，包括痛经、性交痛和非经期盆腔疼痛。分析遵循PRISMA（系统评价和Meta分析的首选报告项目）指南。
制表、整合与结果：共有31项涉及8665名患者的RCT纳入分析。在子宫内膜异位症相关盆腔疼痛方面，与安慰剂相比，四种干预措施显示出显著更高的疗效：亮丙瑞林联合复方口服避孕药（OCP）（标准化均数差[SMD] -1.40，95%CI，-2.41至-0.38）、地诺孕素（SMD -1.20，95%CI，-1.78至-0.61）、单独使用亮丙瑞林（SMD -1.05，95%CI，-1.64至-0.45）和复方OCP（SMD -0.67，95%CI，-1.25至-0.09）。亮丙瑞林联合复方OCP成为最有效的治疗方式。此外，艾拉戈利和维生素C与维生素E的组合被确定为治疗痛经和性交痛最有效的干预措施。对于非经期盆腔疼痛，孕三烯酮与安慰剂及所有其他干预措施相比显示出更高的疗效。
这项网状Meta分析表明，亮丙瑞林联合复方OCP、艾拉戈利、维生素C和E以及孕三烯酮可能是缓解子宫内膜异位症相关盆腔疼痛、痛经、性交痛和非经期盆腔疼痛最有效的治疗选择。这些发现增进了我们对子宫内膜异位症相关疼痛治疗策略相对疗效的理解。未来的研究应专注于在目标患者群体中开展更大规模且设计严谨的临床试验，以进一步验证这些结果。
