Kuntai Capsule plus Hormone Therapy vs. Hormone Therapy Alone in Patients with Premature Ovarian Failure: A Systematic Review and Meta-Analysis

Abstract

The aim of this study was to evaluate the efficacy and safety of Kuntai capsules (KTC) plus hormone therapy (HT) compared to HT alone for the treatment of premature ovarian failure (POF). Databases including PubMed, MEDLINE, Web of Science, China National Knowledge Infrastructure (CNKI), the Chinese BioMedical database (CBM), and the Wanfang database were searched up to October 2018 for randomized controlled trials (RCTs). After screening the studies, extracting the data, and assessing the study quality, Cochrane RevMan 5.3 software was used to conduct a meta-analysis. Twelve RCTs involving 1178 patients were included. Regarding the therapeutic effects, total effective treatment rate was higher for the KTC+HT groups compared to the HT-only groups. Furthermore, compared with HT, KTC+HR effectively altered endocrine indexes involving serum levels of luteinizing hormone (weighted mean difference [WMD]=-3.47, 95% CI [5.68, -1.26], P=0.002]), follicle-stimulating hormone [WMD=-8.15, 95% CI [-10.44, -5.86], P<0.00001], estrogen [WMD=17.21, 95% CI [10.16, 24.26], P<0.00001], and anti-Müllerian hormone [WMD=1.07, 95% CI [0.78, 1.36], P<0.00001]; blood lipid indexes involving serum levels of triglyceride (WMD=-0.55, 95% CI [-0.76, -0.43], P<0.00001), total cholesterol (WMD=-0.63, 95% CI [-0.74, -0.52], P<0.00001), and low-density lipoprotein cholesterol (WMD=-0.62, 95% CI [-0.75, -0.49], P<0.00001); and B-ultrasound results involving ovarian resistance index (WMD=-0.20, 95% CI [-0.35, -0.04], P=0.01), perfusion index (WMD=-0.41, 95% CI [-0.57, -0.24], P<0.00001), peak systolic velocity (WMD=2.43, 95% CI [1.52, 3.34], P<0.00001), antral follicle count (WMD=1.20, 95% CI [0.41, 2.00], P=0.003), and mean ovarian diameter in the plane containing the longest axis of the ovary (WMD=4.34, 95% CI [2.94, 5.74], P<0.00001). There were no serious adverse events in either group. There is evidence that KTC+HT is more effective and safer than HT alone for treating POF. However, the trials had low methodological quality and small samples, so further standardized research is required.

The role of oxidative stress in ovarian aging: a review

“…Several TCM therapies have been demonstrated to modulate ovarian aging by alleviating OS damage. Kuntai capsule is a proprietary Chinese medicine that is widely used to treat menopause syndrome [ 249 ]. Research has shown that Kuntai capsule can upregulate SOD2, reduce ovarian apoptosis and follicular atresia, and increase AMH level in the ovaries of superovulated mice [ 250 ].…”

Identification of the active ingredients and pharmacological effects of Kuntai capsules in the treatment of primary ovarian insufficiency: A review

“…A meta-analysis involving 12 randomized controlled trials revealed that combined treatment with Kuntai capsules and HRT is more effective than HRT alone for POI treatment, including improved serum levels of anti-Mullerian hormone, estradiol, follicle-stimulating hormone, and luteinizing hormone, lipid indexes, and ultrasonic results (antral follicle count, ovarian diameter, ovarian resistance index, peak systolic velocity, and perfusion index). [14] Similarly, a previous study showed that combined therapy with Kuntai capsules and HRT had a higher therapeutic efficacy rate than HRT monotherapy. [15] Moreover, clinical trials have indicated the benefits of Kuntai capsule administration for POI, especially in fertility treatment, including elevation of serum anti-Müllerian hormone levels, estrogen levels, antral follicle counts, increased spontaneous pregnancy rates, and improved assisted reproductive technology outcomes.…”

Research Progress on the Effect of Traditional Chinese Medicine on Signal Pathway Related to Premature Ovarian Insufficiency

“…A meta-analysis of a randomized controlled trial [ 13 ] conducted by Liu et al showed that the total effective treatment rate of Kuntai capsules combined with hormonal therapy for POF was significantly better than that of hormonal therapy alone (OR = 3.76, 95% CI [2.65, 5.35], P < 0.00001). In an experiment, Geng [ 14 ] observed that the Kuntai capsule could improve ovarian reserve by downregulating the levels of FSH and LH, stimulating E 2 secretion, regulating the Bcl-2/Bax ratio among Bcl-2 family protein members, and upregulating the expression of Bcl-2 and Bcl-xl proteins versus downregulating the expression of Bax and Bad proteins to maintain the balance between pro-apoptotic and apoptosis-inhibiting proteins.…”