Efficacy of Dienogest for Prevention of Endometriosis Recurrence

MIDDLE EAST JOURNAL OF FAMILY MEDICINE: Published on November, 2022

A Systematic Review and Meta-Analysis

Endometriosis is a chronic, estrogen-dependent disease that affects 10-15% of women in their reproductive age. It is characterized by the presence of endometriallike tissues outside the uterine cavity that induce chronic inflammation, ovarian cyst formation, and fibrosis. Dysmenorrhea and chronic non-menstrual pelvic pain are the most prevalent symptoms.

For medical treatment of endometriosis associated pain is based on suppression of estrogen production and induction of amenorrhea, and treatments are often accompanied by clinically relevant side effects.

Dienogest is a unique 4th generation synthetic progestogen, which has been approved as a treatment for endometriosis and as part of combined hormonal contraception.

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This systematic review and meta-analysis was undertaken to evaluate the efficacy of postoperative dienogest for prevention of endometriosis recurrence.

The present systematic review and meta-analysis included five studies (three retrospective cohort, and two prospective cohort). It included 608 patients, of whom 216 were managed in the Dienogest Group, while 392 were managed in the Control Group (163 received hormonal suppression, and 228 received no treatment). The follow up period of studies included in the present systematic review ranged from 12 to 60 months

Ths review showed significantly lower endometriosis recurrence rates among patients in the Dienogest Group 8/216, i.e., 3.7 events per 100 treated women over a mean duration of 28.5 months, and 1.3 recurrences per 1000 woman-months.

On the other hand, the recurrence rate of endometriosis in the Control Group was 69/392 recurrences over a mean duration of 29.3 months, i.e., 17.6 per 100 women (6.0 recurrences per 1000 women-months).

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Conclusion:

Patients who receive dienogest following conservative surgery for endometriosis have a significantly lower rate of recurrence, better pain control, and less side effects than their untreated counterparts or those receiving treatment with hormonal suppressive drugs or oral contraceptives.

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Abstract

Aim of Study:

To evaluate the efficacy of postoperative dienogest for prevention of endometriosis recurrence.

Methods:

Several databases were used to search for recent studies (i.e., published in 2016-2020). The search keywords included: “dienogest,” and “endometr*,” Patients who were not treated with dienogest were considered controls. Reviews, comments, animal trials, case reports, abstracts, single-arm studies, low-quality studies, and nonEnglish articles were excluded. The primary outcome of interest was to determine the odds of recurrence in patients who received dienogest compared to controls who were managed expectantly, or offered a substitute hormonal therapy. Secondary outcomes included pain improvement and side effects of received treatment.

Results:

Included studies comprised three retrospective cohort studies, and two prospective cohort studies. These studies included 608 patients; 216 were managed in the Dienogest Group, while 392 were managed in the Control Group (163 received hormonal suppression, and 228 received no treatment). Overall, the recurrence rate of endometriosis in patients receiving Dienogest was 8/216, i.e., 3.7 events per 100 treated women over a mean duration of 28.5 months, and 1.3 recurrences per 1000 woman-months. On the other hand, the recurrence rate of endometriosis in the Control Group was 69/392 recurrences over a mean duration of 29.3 months, i.e., 17.6 per 100 women (6.0 recurrences per 1000 women-months).

Difference in recurrence rates between study groups was statistically significant. Reported recurrence rates were significantly less among patients in the Dienogest Group than those in the Control Group. Generally, patients in the Dienogest Group experienced less pain and less side effects than those in the control group.

Conclusions:

Endometriosis patients who receive dienogest following conservative surgery have a significantly lower rate of recurrence, better pain control, and less side effects than their control counterparts.

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