Can postoperative GnRH agonist treatment prevent endometriosis recurrence? A meta-analysis.

Abstract

To investigate whether postoperative GnRH agonist (GnRH-a) treatment can prevent endometriosis recurrence. This meta-analysis searched PubMed, Embase and Cochrane Library for relevant studies published online before June 2015. Seven randomized controlled trials including 328 patients with postoperative GnRH-a treatment and 394 patients in control group were included in the meta-analysis. In the meta-analysis, the recurrence rate of GnRH-a group compared with control group was evaluated with odds ratio (OR) and its 95% confidence interval (CI). Heterogeneity, small study effect and publication bias were, respectively, assessed using Higgins I (2), sensitivity analysis and funnel plot. Postoperative GnRH-a treatment for endometriosis (pooled OR=0.71; 95% CI 0.52-0.96) was superior to expectant or placebo treatment in prevention of the recurrence. The recurrence rate decreased significantly in patients who received 6months GnRH-a treatment (pooled OR=0.59, 95% CI 0.38-0.90), whereas no significant difference of recurrence rate existed between patients with 3months post-surgical GnRH-a therapy and the control group (pooled OR=0.87, 95% CI 0.56-1.34). No significant heterogeneity and small study effect were found in the meta-analysis. However, publication bias did existed in the present meta-analysis. Longer-term (6months) postoperative administration of GnRH-a can decrease the recurrence risk of endometriosis, whereas 3months duration of GnRH-a therapy makes no significant difference in preventing the recurrence of endometriosis. Therefore, instead of a 3month therapy, the duration of the postoperative administration should be longer enough (6months) to prevent the recurrence of endometriosis.