Abstract
Objective We carried out this systematic review and meta-analysis to evaluate the effectiveness of TKABP on POI. Methods The following eight databases were searched from the establishment to September 30, 2019, for randomized controlled trials (RCTs): PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), the Chinese BioMedical database (CBM), Chinese Scientific Journal Database (VIP), and the Wanfang database. The quality of evidence was estimated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results Twenty-three RCTs involving 1712 patients with POI were included. Compared to hormone therapy (HT) groups, TKABP groups showed a significantly higher total effective rate (RR: 1.10; 95% CI: 1.04–1.17; P < 0.01, I2 = 32%). In addition, TKABP groups revealed a better improvement in terms of serum follicle-stimulating hormone (FSH) levels, serum estradiol (E2) levels, peak systolic velocity (PSV) of ovarian stromal blood, and Kupperman index (KI) score. However, serum luteinizing hormone (LH) levels and ovarian volume (OV) showed no significant statistical difference. Subgroup analyses showed that herbal paste and 3 months of treatment duration had a greater effect on the improvement of hormone levels. Besides, the occurrence of related adverse events in TKABP groups was lower than that in HT groups. Conclusions Our review suggests that TKABP appears to be an effective and safe measure for patients with POI, and the herbal paste may be superior. However, the methodological quality of included RCTs was unsatisfactory, and it is necessary to verify its effectiveness with furthermore standardized researches of rigorous design.
Highlights
Premature ovarian insufficiency (POI) is currently considered the most apposite term to denote the loss of ovarian function caused by an abnormal and accelerated depletion of ovarian reserve in women before the age of forty [1]
Inclusion Criteria. e inclusion criteria include the following: (1) population: patients diagnosed with POI, regardless of ethnicity or nationality; (2) intervention: the therapy of Chinese herbal medicine tonifying kidney and activating blood was clearly stated in the trial group with no limitation in prescription name, dosage form, dosage, and course of treatment; (3) comparison: the comparison that tonifying kidney and activating blood prescription only versus Hormone therapy (HT), no treatment, placebo, or sham treatment was investigated; (4) outcome: reporting the effect of TKABP for POI; and (5) study design: random controlled trial
Patients treated with TKABP had significantly lower Kupperman scores (SMD: −0.78; 95% confidence interval (CI): −1.24, −0.31; P < 0.05, I2 81%, Figure 7) and significantly higher peak systolic velocity (PSV) of ovarian stromal blood (SMD: 0.45; 95% CI: 0.16, 0.74; P < 0.05, I2 0%, Figure 8)
Summary
Premature ovarian insufficiency (POI) is currently considered the most apposite term to denote the loss of ovarian function caused by an abnormal and accelerated depletion of ovarian reserve in women before the age of forty [1]. It was characterized with the declining levels of normal hormonal and reproductive function [2]with the prevalence in the general population being approximately 1% [1]. Hormone therapy (HT), one of the most commonly methods used to treat POI, only aims to relieve the signs and symptoms of POI and may cause hepatic damage, vascular conditions, and cancer risk with long-term treatment [11]
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