Medical Therapies for Uterine Fibroids - A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials
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 rec...
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| description | 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.
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.
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.
Two authors independently extracted data from identified studies.
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.
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.
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. |
| doi_str_mv | 10.1371/journal.pone.0149631 |
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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.
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.
Two authors independently extracted data from identified studies.
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.
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.
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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0149631</identifier><identifier>PMID: 26919185</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Bayesian analysis ; Care and treatment ; Citation analysis ; Classification ; Diagnosis ; Drug dosages ; Drug therapy ; Female ; Fertility ; Fibroids ; Gynecology ; Health services ; Hospitals ; Humans ; Hysterectomy ; Laparoscopy ; Leiomyoma - drug therapy ; Libraries ; Medical research ; Medical treatment ; Medicine and Health Sciences ; Meta-analysis ; Obstetrics ; Pain ; Patient outcomes ; Pharmacology ; Physical Sciences ; Physiological aspects ; Quality of life ; Randomization ; Randomized Controlled Trials as Topic ; Research and Analysis Methods ; Short term ; Surgery ; Urogenital surgery ; Uterine fibroids ; Uterine Neoplasms - drug therapy ; Uterus ; Veins & arteries ; Womens health</subject><ispartof>PloS one, 2016-02, Vol.11 (2), p.e0149631-e0149631</ispartof><rights>COPYRIGHT 2016 Public Library of Science</rights><rights>2016 Gurusamy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2016 Gurusamy et al 2016 Gurusamy et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-4ef457d8f61ad93cb66de41417b386797e14fa6924db22dd58dfbf25d12e6cd63</citedby><cites>FETCH-LOGICAL-c692t-4ef457d8f61ad93cb66de41417b386797e14fa6924db22dd58dfbf25d12e6cd63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769153/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769153/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26919185$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gurusamy, Kurinchi S</creatorcontrib><creatorcontrib>Vaughan, Jessica</creatorcontrib><creatorcontrib>Fraser, Ian S</creatorcontrib><creatorcontrib>Best, Lawrence M J</creatorcontrib><creatorcontrib>Richards, Toby</creatorcontrib><title>Medical Therapies for Uterine Fibroids - A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.
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.
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.
Two authors independently extracted data from identified studies.
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.
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.
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.</description><subject>Bayesian analysis</subject><subject>Care and treatment</subject><subject>Citation analysis</subject><subject>Classification</subject><subject>Diagnosis</subject><subject>Drug dosages</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Fertility</subject><subject>Fibroids</subject><subject>Gynecology</subject><subject>Health services</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hysterectomy</subject><subject>Laparoscopy</subject><subject>Leiomyoma - drug therapy</subject><subject>Libraries</subject><subject>Medical research</subject><subject>Medical treatment</subject><subject>Medicine and Health Sciences</subject><subject>Meta-analysis</subject><subject>Obstetrics</subject><subject>Pain</subject><subject>Patient outcomes</subject><subject>Pharmacology</subject><subject>Physical Sciences</subject><subject>Physiological aspects</subject><subject>Quality of life</subject><subject>Randomization</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Research and Analysis Methods</subject><subject>Short term</subject><subject>Surgery</subject><subject>Urogenital surgery</subject><subject>Uterine fibroids</subject><subject>Uterine Neoplasms - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gurusamy, Kurinchi S</au><au>Vaughan, Jessica</au><au>Fraser, Ian S</au><au>Best, Lawrence M J</au><au>Richards, Toby</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Medical Therapies for Uterine Fibroids - A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2016-02-26</date><risdate>2016</risdate><volume>11</volume><issue>2</issue><spage>e0149631</spage><epage>e0149631</epage><pages>e0149631-e0149631</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.
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.
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.
Two authors independently extracted data from identified studies.
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.
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.
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26919185</pmid><doi>10.1371/journal.pone.0149631</doi><oa>free_for_read</oa></addata></record> |
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| issn | 1932-6203 1932-6203 |
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| recordid | cdi_plos_journals_1771272111 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Bayesian analysis Care and treatment Citation analysis Classification Diagnosis Drug dosages Drug therapy Female Fertility Fibroids Gynecology Health services Hospitals Humans Hysterectomy Laparoscopy Leiomyoma - drug therapy Libraries Medical research Medical treatment Medicine and Health Sciences Meta-analysis Obstetrics Pain Patient outcomes Pharmacology Physical Sciences Physiological aspects Quality of life Randomization Randomized Controlled Trials as Topic Research and Analysis Methods Short term Surgery Urogenital surgery Uterine fibroids Uterine Neoplasms - drug therapy Uterus Veins & arteries Womens health |
| title | Medical Therapies for Uterine Fibroids - A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials |
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