Comparative effectiveness of acupuncture and HRT interventions for premature ovarian failure : a bayesian meta-analysis

Premature ovarian failure (POF) is the loss of normal function of the ovaries before age 40. While hormone replacement therapy (HRT) significantly improves the effective rate of patients with POF, it may also raises a woman’s risk of heart disease and breast cancer. Acupuncture is a form of alternative medicine and has been sanctioned by many countries. Acupuncture is usually safe and has definite effect without side effects on the treatment of patients with POF, so long as it is administered by experienced physicians. This Bayesian meta-analysis of randomized trials was designed to synthesize the evidence of the comparative effectiveness of Acupuncture and HRT interventions used for patients with POF. Seven electronic literature databases, including Cochrane Library, PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), Chongqing VIP, Wanfang DATA and the Chinese Biomedicine (CBM) databases, were searched for relevant randomized controlled trials until September 20, 2016. Only RCTs that compared acupuncture to HRT alone for women POF were selected. Study selection and data extraction were carried out by two reviewers independently. Study quality was assessed with the Cochrane Collaboration risk of bias tool. Results were pooled by a hierarchical Bayesian random-effects model with parameters used non-informative prior distributions. The primary outcomes examined were follicle-stimulating hormone (FSH), estradiol (E2), luteinizing hormone (LH) and effective rate after treatment in both Acupuncture groups and HRT groups. The 2-level hierarchical Bayesian random effect models were developed to estimate posterior means and 95% credible intervals (CrI) for mean difference (MD) of hormonal levels (FSH, E2, LH) and pooled odds ratio (OR) of effective cases. Eight studies involving 735 patients (368 with acupuncture treatment, 367 with HRT treatment) with POF were included in the meta-analysis. The posterior means and 95% CrI for pooled OR (5.587, [3.095, -9.196]) showed between-group difference and a higher effective rate of patients with acupuncture than with HRT interventions. Compared to HRT treatment, included studies in this review showed that acupuncture therapy was effective in reducing the levels of FSH (MD=-7.691, 95% CrI: -11.87 to -3.91) and increasing the levels of E2 (MD=26.670, 95% CrI: 3.004 to 49.85), whereas acupuncture therapy had no effect on reducing the levels of LH (-3.164, 95% CrI: -6.815 to 1.292). In addition, there was no evidence of significant publication bias. The results of sensitivity analyses showed that pooled OR and MD estimates were influenced by no single study. In conclusion, this Bayesian meta-analysis provides evidence that acupuncture therapy is superior to HRT in some areas of comparisons, including effective rate, reduced the level of FSH and increased the E2 level. However, there is no evidence that acupuncture therapy has effect on reducing the levels of LH compared to HRT treatment. High quality and well-designed studies are needed to enhance the credibility of the results about the effectiveness of acupuncture in patients with POI.