A Systematic Review and Meta-analysis of Dane Fukang Decoction and Gestrinone for Treatment of Endometriosis

Preeyanuch  Ketprathum; Hathaikan  Chootrakool; Chuleekorn  Sritonchai; Chukiat  Viwatwongkasem; Jutatip  Sillabutra

Authors

Preeyanuch Ketprathum Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand
Hathaikan Chootrakool Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand
Chuleekorn Sritonchai Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Chukiat Viwatwongkasem Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand
Jutatip Sillabutra Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand

Keywords:

Meta-analysis, random-effects model, heterogeneity assessment, treatment effectiveness

Abstract

Endometriosis is a chronic gynecological condition influenced by hormones that frequently causes severe pelvic pain and other concerning symptoms such as heavy or irregular menstrual bleeding, painful intercourse, fatigue, nausea, and infertility. While surgery is often required, the rates of recurrence after surgery remain high. Objective. This systematic review and meta-analysis aimed to determine the efficacy of Dane Fukang decoction and Gestrinone for treating endometriosis after surgery. A literature search was conducted in the primary electronic databases, with studies published from inception until January 2024. The analysis included in randomized controlled trials (RCTs) that compared Dane Fukang decoction to Gestrinone for endometriosis treatment after surgery. Meta-analyses were conducted using random-effects models, calculating pooled odds ratios (OR) and 95% confidence intervals (CI). A total of six RCTs involving 658 patients were included. The meta-analysis showed that Dane Fukang decoction significantly improved effectiveness compared to gestrinone treatments. The random effect model analysis yielded an odds ratio of 2.72 (95% CI: 1.13 to 6.54, p=0.05) with an I2 value of 56%, suggesting moderate heterogeneity among the included studies. No serious adverse events were reported with either intervention. This systematic review and meta-analysis provide evidence supporting the superior efficacy of Dane Fukang decoction over gestrinone as a post-operative treatment for endometriosis to improve overall clinical outcomes.

References

Armour, M., Parry, K., Manohar, N., Holmes, K., Ferfolja, T., Curry, C., et al. (2019). The prevalence and academic impact of dysmenorrhea in 21,573 young women: A systematic review and meta-analysis. Journal of Women’s Health, 28(8), 1161–1171.

Brown, J., Crawford, T. J., Datta, S., & Prentice, A. (2018). Oral contraceptives for pain associated with endometriosis. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001019.pub3

Caixia, Z., & Li, L. (2007). Observation on the efficacy of Dan’e Fukang decoction in the adjuvant treatment of ovarian endometriosis cysts after surgery in 40 cases. Chinese Journal of Integrated Traditional Chinese and Western Medicine, 27(1), 87–88.

Chootrakool, H., Shi, J. Q., & Yue, R. (2011). Meta-analysis and sensitivity analysis for multi-arm trials with selection bias. Statistics in Medicine, 30(11), 1183–1198.

Chootrakool, H., & Treewai, P. (2022). Meta-analysis of multi-arm trials using binomial approach. Open Journal of Statistics, 12(1), 15–32.

de Souza Pinto, L. P., Ferrari, G., Dos Santos, I. K., de Mello Roesler, C. R., & de Mello Gindri, I. A. (2023). Evaluation of safety and effectiveness of gestrinone in the treatment of endometriosis: A systematic review and meta-analysis. Archives of Gynecology and Obstetrics, 308(2), 513–526.

Donnez, J., & Dolmans, M. M. (2021). Endometriosis and medical therapy: From progestogens to progesterone resistance to GnRH antagonists: A review. Journal of Clinical Medicine, 10(5), 1085. https://doi.org/10.3390/jcm10051085

Gao, X., Yeh, Y. C., Outley, J., Simon, J., Botteman, M., & Spalding, J. (2006). Health-related quality of life burden of women with endometriosis: A literature review. Current Medical Research and Opinion, 22(9), 1787–1797.

Giudice, L. C., & Kao, L. C. (2004). Endometriosis. The Lancet, 364(9447), 1789–1799.

Guiying, Z. (2013). Observation on the clinical efficacy of combined drug treatment for ovarian chocolate cyst after laparoscopic surgery. China Medical Herald, 11(2), 293. https://doi.org/10.14163/j.cnki.11-5547/r.2018.02.056

Guo, S. W. (2009). Recurrence of endometriosis and its control. Human Reproduction Update, 15(4), 441–461.

Holoch, K. J., & Lessey, B. A. (2010). Endometriosis and infertility. Clinical Obstetrics and Gynecology, 53(2), 429–438.

Hong, X. (2011). The efficacy and safety of Dan’e Fukang decoction on endometriosis. Capital Medicine, 18(22), 34–35.

Kunsanprasit, N., Chootrakool, H., Thanapluetiwong, S., Soontornpipit, P., & Viwatwongkasem, C. (2024). Systematic review and meta-analysis of diagnostic Alzheimer’s disease with blood biomarkers. Thai Journal of Public Health, 54(2), 874–889.

Lee, W. J., Chan, C. P., & Wang, B. Y. (2013). Recent advances in laparoscopic surgery. Asian Journal of Endoscopic Surgery, 6(1), 1–8.

Li, Y., Li, T., & Song, S. (2017). Evaluation of efficacy and safety of Dan’e-Fukang soft extract in the treatment of endometriosis: A meta-analysis of 39 randomized controlled trials enrolling 5442 patients. Evidence-Based Complementary and Alternative Medicine, 2017, 9767391. https://doi.org/10.1155/2017/9767391

Longping, H. (2019). The effect of laparoscopic surgery combined with different drugs in the treatment of ovarian chocolate cyst. Chinese Medical Guide, 17(35), 97–98.

Mastroianni, L., Jr. (1999). The fallopian tube and reproductive health. Journal of Pediatric and Adolescent Gynecology, 12(3), 121–126.

Pirri, C. (2012). Complementary and alternative medicine used by patients with cancer: Evidence for efficacy and safety. In Perspectives on Complementary and Alternative Medicine (pp. 31–87).

Scholl, B., Bersinger, N. A., Kuhn, A., & Mueller, M. D. (2009). Correlation between symptoms of pain and peritoneal fluid inflammatory cytokine concentrations in endometriosis. Gynecological Endocrinology, 25(11), 701–706.

Shafrir, A. L., Farland, L. V., Shah, D. K., Harris, H. R., Kvaskoff, M., Zondervan, K., et al. (2018). Risk for and consequences of endometriosis: A critical epidemiologic review. Best Practice & Research Clinical Obstetrics & Gynaecology, 51, 1–15.

Smolarz, B., Szyłło, K., & Romanowicz, H. (2021). Endometriosis: Epidemiology, classification, pathogenesis, treatment and genetics (review of literature). International Journal of Molecular Sciences, 22(19), 10554. https://doi.org/10.3390/ijms221910554

Xiurong, Z., & Rong, C. (2017). Analysis of the effect of combined drug treatment on ovarian chocolate cyst after laparoscopic surgery. Primary Medical Forum, 21(32). https://doi.org/10.19435/j.1672-1721.2017.32.119

Zhong, Y. C., Zhou, X. F., Hou, C. M., & Li, W. P. (2019). Effect of Dan’e Fukang on symptoms and biomarkers in women with endometriosis. Taiwanese Journal of Obstetrics and Gynecology, 58(4), 514–519.

Ziyan, L. (2012). Ninety-four cases of ovarian chocolate cyst treated with Dan’e Fukang decoction after laparoscopic surgery. Modern Distance Education of Chinese Medicine, 10(2). https://doi.org/10.3969/j.issn.1672-2779.2012.02.036