Quantitative study on the efficacy of acupuncture in the treatment of menopausal hot flashes and its comparison with nonhormonal drugs.

Ting Li,Lujin Li,Qingqing Cheng,Qingshan Zheng,Mengyuan Hou,Yi Zhang,Xijun Zheng

doi:10.1097/gme.0000000000001767

Abstract

This study aimed to compare the efficacy of acupuncture to that of sham acupuncture, placebo pills, and nonhormonal drugs to provide the necessary quantitative information for establishing medication guidelines for menopausal hot flashes. A comprehensive literature search was performed using public databases. Randomized clinical studies on acupuncture therapy for the treatment of hot flashes in menopausal women were identified. A time-course model was established to describe the efficacy characteristics of acupuncture and sham acupuncture, which were compared with the efficacy of nonhormonal drugs and placebo pills reported in the literature. A total of 17 studies involving 1,123 participants were included. The quality of all the studies included in the analysis is medium to high, and there was no obvious risk of bias. It was found that the baseline number of hot flashes was an important factor affecting the efficacy of acupuncture and sham acupuncture. After correcting the baseline to eight hot flashes per day, the frequency of hot flashes decreased from baseline for traditional acupuncture (TA), electro-acupuncture (EA), TA&EA (merger analysis of TA and electro-acupuncture), and sham acupuncture were 3.1 (95% confidence interval [CI]: 2.8-3.4), 3.6 (95% CI: 3.2-4.0), 3.2 (95% CI: 2.9-3.5), and 2.6 (95% CI: 2.2-3.0) times/d at week 8, respectively. Compared with findings reported in the literature, we found the efficacy of electro-acupuncture was comparable to that of selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors and neuroleptic agents such as gabapentin and escitalopram. Furthermore, the efficacy of TA&EA (merged) was significantly higher than that of placebo pills (2.3, 95% CI: 1.8-2.9). The efficacy of TA&EA (merged) was higher than that of sham acupuncture and significantly higher than that of placebo pills. The efficacy of electro-acupuncture was higher than that of traditional acupuncture, significantly higher than that of sham acupuncture, and comparable to that of selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors and neuroleptic agents.

Highlights

The efficacy of acupuncture in the treatment of menopausal hot flashes has always been controversial, which limited the use of acupuncture
After correcting the baseline to eight hot flashes per day, the frequency of hot flashes decreased from baseline for traditional acupuncture (TA), electro-acupuncture (EA), TA&EA, and sham acupuncture (SA) were 3.1, 3.6, 3.2, and 2.6 times/day at week 8, respectively
Compared with findings reported in the literature, we found the efficacy of EA was comparable to that of selective serotonin reuptake inhibitors/serotonin–norepinephrine reuptake inhibitors (SSRIs/serotonin norepinephrine reuptake inhibitors (SNRIs)) and neuroleptic agents such as gabapentin and escitalopram

Summary

Introduction

The efficacy of acupuncture in the treatment of menopausal hot flashes has always been controversial, which limited the use of acupuncture. This study aimed to compare the efficacy of acupuncture to that of sham acupuncture (SA), placebo pills, and non-hormonal drugs to provide the necessary quantitative information for establishing medication guidelines for menopausal hot flashes. The selective serotonin reuptake inhibitor (SSRI) paroxetine was approved by the US Food and Drug Administration (FDA) in 2013 and was the first non-hormonal drug approved for the treatment of menopausal hot flashes [4]. Other non-hormonal drugs such as gabapentin, clonidine, SSRIs (except paroxetine), and serotonin norepinephrine reuptake inhibitors (SNRIs) are often used off-label to treat menopausal hot flashes [6、7、8、9]. In addition to a wide range of central side effects and the risk of drug interactions [10], the efficacies of these drugs fail to demonstrate much of an advantage and their maximum efficacy is no more than half of that of estradiol [5]

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Methods

Results

Discussion

Conclusion