The Effect of Letrozole Combined with Dydrogesterone for Endometriosis in China: A Meta‐Analysis

Abstract

Purpose. To discuss the effects of dydrogesterone combined with letrozole on the effectiveness, sex hormone levels, and serological indicators in patients with endometriosis. This study is registered with PROSPERO (CRD42020213172). Methods. We searched relevant randomized controlled trials (RCTs) through PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP Database. The standardized mean differences (SMDs), the mean differences (MDs), or odds ratios (ORs) with their 95% confidence intervals (95% CIs) were computed to be outcome indicators, including total effectiveness, Vascular Endothelial Growth Factor (VEGF) level, Carbohydrate Antigen 125 (CA125) level, Follicle-Stimulating Hormone (FSH) level, Luteinizing Hormone (LH) level, estrogen (E2) level, progesterone (P) level, interleukin-6 (IL-6) level, and tumor necrosis factor-a (TNF-a) level. Results. A total of 19 RCTs involving 1,591 patients were included in this study. Our results showed that letrozole combined with dydrogesterone can significantly reduce the levels of VEGF (SMD -2.23, 95% CI -2.39 to -2.07; p < 0.00001 ), CA125 (MD -10.53, 95% CI -11.19 to -9.88; p < 0.00001 ), E2 (SMD -1.64, 95% CI -1.81 to -1.47; p < 0.00001 ), P (MD -5.11, 95% CI -6.26 to -3.96; p < 0.00001 ), IL-6 (MD -4.41, 95% CI -5.16 to -3.67; p < 0.00001 ), and TNF-a (MD -5.67, 95% CI -6.34 to -5.00; p < 0.00001 ) in patients with endometriosis compared with the control group. In addition, the results indicated that total effectiveness was significantly higher in the experiment group (OR 6.21, 95% CI 4.17 to 9.24; p < 0.00001 ) compared to the control. However, there was no significant difference between FSH and LH levels in both groups ( p > 0.05 ). Conclusion. This combination therapy can effectively decrease the levels of VEGF, CA125, E2, P, IL-6, and TNF-a and increase the total effectiveness when comparing with the control group.

A Systematic Review of Systematic Reviews on the Use of Aromatase Inhibitors for the Treatment of Endometriosis: The Evidence to Date

“…Finally, 24 studies were selected for inclusion, 5 were Systematic reviews 10–14 and 19 were Narrative reviews. 15–33 The PRISMA flowchart of the process of the selection of the studies is exhibited in Figure 2 The systematic reviews dated from 2008 to 2021 10 , 14 and the narrative reviews dated from 1999 to 2018. 15 , 33 The majority of the studies originated from the USA (n = 9)-37.5%, 15–17 , 20 , 22 , 24 , 25 , 27 , 28 followed by Italy (n = 7)-29.1% 12 , 13 , 19 , 23 , 29 , 31 , 33 and Belgium (n = 2)-8.3% 18 , 26 the rest of the countries UK, 10 Greece, 11 China, 14 Turkey, 21 Egypt 30 Poland 32 presented with one study,(n=1)-4.1%.…”

“…10–14 The studies originated from UK, 10 Greece, 11 Italy 12 , 13 and China. 14 The clinical data of the included systematic reviews are exhibited in Table 1 .…”

Individualized conservative therapeutic strategies for adenomyosis with the aim of preserving fertility

“…The patient can be pregnant during the medication of dydrogesterone, so it is especially suitable for adenomyosis patients with a recent pregnancy plan (27). Dydrogesterone is rapidly absorbed by oral administration with short half-life, and has obvious effect on inhibiting endometrial proliferation without causing low estrogen symptoms or affecting lipid metabolism and blood system (28). Thus it is safe for long-term use and suitable for patients above 40 years old, or those with high risks of metabolic and thrombotic diseases.…”

“…Thus it is safe for long-term use and suitable for patients above 40 years old, or those with high risks of metabolic and thrombotic diseases. Dydrogesterone is also often used in combination with other treatments ( 29 ). Due to the widespread use of didroxyprogesterone in other fields of gynecology and reproductive medicine, patients with adenomyosis have higher acceptance and compliance with it ( 29 , 30 ).…”

“…Dydrogesterone is also often used in combination with other treatments ( 29 ). Due to the widespread use of didroxyprogesterone in other fields of gynecology and reproductive medicine, patients with adenomyosis have higher acceptance and compliance with it ( 29 , 30 ).…”