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. 2016 Feb 26;11(2):e0149631.
doi: 10.1371/journal.pone.0149631. eCollection 2016.

Medical Therapies for Uterine Fibroids - A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials

Kurinchi S Gurusamy  1 , Jessica Vaughan  1 , Ian S Fraser  2   3 , Lawrence M J Best  1 , Toby Richards  1
Affiliations

Medical Therapies for Uterine Fibroids - A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials

Kurinchi S Gurusamy et al. PLoS One. .

Abstract

Background: Uterine fibroids are common, often symptomatic and a third of women need repeated time off work. Consequently 25% to 50% of women with fibroids receive surgical treatment, namely myomectomy or hysterectomy. Hysterectomy is the definitive treatment as fibroids are hormone dependent and frequently recurrent. Medical treatment aims to control symptoms in order to replace or delay surgery. This may improve the outcome of surgery and prevent recurrence.

Purpose: To determine whether any medical treatment can be recommended in the treatment of women with fibroids about to undergo surgery and in those for whom surgery is not planned based on currently available evidence.

Study selection: Two authors independently identified randomised controlled trials (RCT) of all pharmacological treatments aimed at the treatment of fibroids from a list of references obtained by formal search of MEDLINE, EMBASE, Cochrane library, Science Citation Index, and ClinicalTrials.gov until December 2013.

Data extraction: Two authors independently extracted data from identified studies.

Data synthesis: A Bayesian network meta-analysis was performed following the National Institute for Health and Care Excellence-Decision Support Unit guidelines. Odds ratios, rate ratios, or mean differences with 95% credible intervals (CrI) were calculated.

Results and limitations: A total of 75 RCT met the inclusion criteria, 47 of which were included in the network meta-analysis. The overall quality of evidence was very low. The network meta-analysis showed differing results for different outcomes.

Conclusions: There is currently insufficient evidence to recommend any medical treatment in the management of fibroids. Certain treatments have future promise however further, well designed RCTs are needed.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Reference flow diagram.
Fig 2
Fig 2. Medical treatment versus surgical treatments for uterine fibroids—proportion undergoing abdominal hysterectomy—forest plot.
Fig 3
Fig 3. Different medical treatments in those not scheduled to undergo surgery—rankogram.
Fig 4
Fig 4. Different presurgical medical treatments—rankogram.
See this image and copyright information in PMC

References

    1. Baird DD, Hill MC, Schectman JM, Hollis BW. Vitamin d and the risk of uterine fibroids. Epidemiology. 2013;24(3):447–53. 10.1097/EDE.0b013e31828acca0 . - DOI - PMC - PubMed
    1. Marsh EE, Ekpo GE, Cardozo ER, Brocks M, Dune T, Cohen LS. Racial differences in fibroid prevalence and ultrasound findings in asymptomatic young women (18–30 years old): a pilot study. Fertility and sterility. 2013;99(7):1951–7. 10.1016/j.fertnstert.2013.02.017 . - DOI - PMC - PubMed
    1. Myers SL, Baird DD, Olshan AF, Herring AH, Schroeder JC, Nylander-French LA, et al. Self-report versus ultrasound measurement of uterine fibroid status. Journal of women's health. 2012;21(3):285–93. 10.1089/jwh.2011.3008 - DOI - PMC - PubMed
    1. Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC women's health. 2012;12:6 10.1186/1472-6874-12-6 - DOI - PMC - PubMed
    1. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. American journal of obstetrics and gynecology. 2003;188(1):100–7. . - PubMed

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