Comparison of the Effectiveness of Various Medicines in the Prevention of Ovarian Hyperstimulation Syndrome: A Network Meta-Analysis of Randomized Controlled Trials

• Published in: Frontiers in endocrinology (Lausanne) Vol. 13; p. 808517
• Main Authors: Wu, Di, Shi, Hao, Yu, Yiping, Yu, Ting, Zhai, Jun
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 26.01.2022
• Subjects: Cabergoline; controlled ovulation stimulation; Endocrinology; Female; Humans; Network Meta-Analysis; OHSS; ovarian hyperstimulation syndrome; Ovarian Hyperstimulation Syndrome - epidemiology; Ovarian Hyperstimulation Syndrome - prevention & control; Pregnancy; Pregnancy Rate; Randomized Controlled Trials as Topic; various drugs; ovarian hyperstimulation syndrome; various drugs; OHSS; network meta-analysis; controlled ovulation stimulation
• ISSN: 1664-2392; 1664-2392
• DOI: 10.3389/fendo.2022.808517

Previous studies have described the effects of different drugs in preventing ovarian hyperstimulation syndrome (OHSS). However, the efficacies of those drugs in preventing OHSS remain inconclusive. We searched the PubMed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. A network meta-analysis of randomized controlled trials (RCTs) was performed up to August 2021. We investigated the following drugs in our study: aspirin, albumin, metformin, calcium, cabergoline, quinagolide, letrozole, hydroxyethyl starch (HES), and glucocorticoids. The primary outcome was the incidence rate of moderate-to-severe OHSS, with the results presented as risk ratios (RRs) with 95% confidence intervals (CIs). The incidence of moderate-to-severe OHSS was significantly reduced by calcium administration (risk ratios [RR] 0.14, 95% confidence interval [CI]: 0.04, 0.46) (grade: high), HES (RR 0.25, 95% CI 0.07, 0.73) (grade: high), and cabergoline (RR 0.43, 95% CI 0.24, 0.71) (grade: moderate). The surface under the cumulative ranking curve (SUCRA) indicated that calcium (SUCRA, 92.4%) was the most effective intervention for preventing moderate-to-severe OHSS. These drugs were safe and did not affect clinical pregnancy, miscarriage, or live birth rates. Calcium, HES, and cabergoline could effectively and safely prevent moderate-to-severe OHSS, with calcium as the most effective intervention.