Systematic evaluation on the clinical efficacy of acupoint stimulation therapy for treatment of premature ovarian insufficiency on the basis of network Meta-analysis

Abstract

ObjectiveTo systematically evaluate the effectiveness and safety of acupoint stimulation therapy for treatment of premature ovarian insufficiency (POI). MethodsComputer retrieval was carried out in such databases as PubMed, Embase, Cochrane Library, web of science, Chinese biomedicine database (CBM), China National Knowledge Infrastructure (CNKI), WanFang and VIP in order to collect the randomized controlled trials (RCT) concerning acupoint stimulation therapy for treatment of POI. Software R 3.40 and stata 14.0 were used for Meta-analysis and network Meta-analysis, and RevMan 5.3 was used for plotting the risk bias diagrams. ResultsForty-three RCTs were included in total, involving 3046 POI patients and 18 acupoint stimulation therapies and comprehensive therapies. Meta-analysis showed: ▪ The curative effects of acupoint stimulation therapy (RR=1.25, 95%CI [1.07,1.45]), acupoint stimulation therapy+Chinese herbal medicine (RR=1.25, 95%CI [1.18,1.32]) and acupoint stimulation therapy+ hormone replacement therapy (HRT) (RR=1.20, 95%CI [1.12,1.29]) were all superior to that of HRT, indicating that the differences were statistically significant (Z=2.90, P=0.04; Z=7.56, P<0.000 01; Z=4.06, P<0.000 01). ▪ Compared with HRT, the occurrence rate of adverse effect of acupoint stimulation therapy was lower, and the safety was superior to that of HRT (RR=0.18, 95%CI [0.08,0.41]), indicating that the differences were statistically significant (Z=4.08, P<0.0001). Forty-two direct comparisons and 110 indirect comparisons were generated according to network Meta-analysis, among which, 38 comparisons were statistically significant. Network Meta-analysis results with HRT as control showed: the therapeutic measures ranking top 3 according to the curative effect sequence were catgut embedment in acupoint, moxibustion and warming-needle moxibustion, successively, and all the 3 measures were monotherapies without reflecting the advantages of comprehensive therapy. HRT ranked 17th among the 18 included therapeutic measures. ConclusionOn the basis of current evidences, acupoint stimulation therapy has a better clinical efficacy and safety for treatment of POI when compared with HRT. The acupoint stimulation therapies ranking the top 3 have more significant curative effects, but the long-term efficacy and the effect on the ovarian function still need to be further explored. In addition, the conclusion of this study still needs to be verified through a large number of RCTs with reasonable designs and appropriate methods.