Abstract
Objective: To compare the efficacy of various listed Chinese patent medicines combined with letrozole in the treatment of ovulation disorders using network meta-analysis (NMA). Methods: We conducted a systematic literature search in PubMed, Cochrane Central Register of Controlled Trials, Embase, Chinese Biomedical Literature, China National Knowledge Infrastructure, Wanfang, and VIP Information databases up to June 2020. Randomized controlled trials reporting Chinese patent medicine combined with letrozole for ovulation disorders were included. The Stata 13 and WinBUGS1.43 software were used for data analysis. Results: A total of 24 randomized controlled trials were included, involving 2,318 patients. The results showed that when compared with patients using only letrozole, the ovulation rate was higher in patients using letrozole combined with Kuntai capsules, Fuke Zaizao capsules, Fufang Xuanju capsules, or Dingkun Dan, and Fufan Xuanju capsules showed the greatest improvement; the pregnancy rate was higher in patients using letrozole combined with Kuntai capsules, Fuke Zaizao capsules, or Dingkun Dan; and the endometrial thickness on the day of follicular maturity was greater in patients using letrozole combined with Kuntai capsules, Fuke Zaizao capsules, Fufang Xuanju capsules, Bailing capsules, or Dingkun Dan. In terms of the sequencing of NMA results, Fufang Xuanju capsules combined with letrozole gave the best results in improving the ovulation rate and increasing the endometrial thickness, while Dingkun Dan combined with letrozole achieved the best results for improving the pregnancy rate. Conclusion: Letrozole combined with Chinese patent medicine is more effective than letrozole alone in the treatment of ovulation disorders. Fufang Xuanju capsules is good at improving the ovulation rate and increasing the endometrial thickness. Dingkun Dan is good at improving the pregnancy rate. The appropriate choice of treatment should be made according to the actual clinical situation. This study is registered with the International Prospective Register of Systematic Reviews (CRD42020200603).
Highlights
Ovulation disorders are a common cause of infertility or difficulty in achieving pregnancy in women of childbearing age
The subjects of this study were patients with ovulation disorders, all of whom were from studies that involved double-arm clinical trials, and a total of six kinds of Chinese patent medicine preparations were included from 15 studies of Kuntai capsules, two studies of Fuke Zaizao capsules, two studies of Fufang Xuanju capsules, 1 study of Fuke Yangying capsules, 1 study of Bailing capsules, and three studies of Dingkun Dan
Results of the Network Meta-Analysis of the Three Outcome Indicators Ovulation Rate A total of 12 studies (Ji et al, 2015; Jian and Bai, 2016; Liu, 2017; Ma, 2018; Yu et al, 2018; Liu, 2019; Yang et al, 2019; Zhong et al, 2019; Chu et al, 2020; Li, 2020; Liang et al, 2020; Wei et al, 2020) reported the ovulation rate after treatment, which was higher in patients using letrozole combined with Kuntai capsules, Fuke Zaizao capsules, Fufang Xuanju capsules, or Dingkun Dan than in those using only letrozole and was significantly higher in patients using Fufang Xuanju capsules combined with letrozole than in patients using the other combinations, but there was no statistically significant difference between the other treatment results
Summary
Ovulation disorders are a common cause of infertility or difficulty in achieving pregnancy in women of childbearing age. Many clinical studies have proven that a combination of Chinese patent medicine and letrozole in the treatment of ovulation disorders is more effective than using letrozole alone, and the combination of these drugs can increase the ovulation and pregnancy rates of patients and improve endometrial receptivity. Some of these studies have included meta-analyses of the combined treatment of some Chinese patent medicines and letrozole. There are currently few studies that have compared the efficacy of different Chinese patent medicines, making it difficult to evaluate the efficacy of various Chinese patent medicines when combined with letrozole in the treatment of ovulation disorders. Network meta-analysis (NMA) can summarize the existing evidence through direct comparisons, provide useful information through indirect comparisons, and rank the effects of various interventions to provide insights into the advantages and disadvantages of these interventions
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