Efficacy and Safety of Cangfu Daotan Decoction As an Adjuvant Treatment of Diane-35 for Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis

Overview

Journal Heliyon

Specialty Social Sciences

Date 2024 Sep 16

PMID 39281507

Authors

Xianjie Feng

Shaomin Cheng

Sheng Xu

Xin Chen

Xu Zhou

Affiliations

Soon will be listed here.

Abstract

Objective: Cangfu Daotan decoction is a classic traditional Chinese medicine formula that has been found to be beneficial for treating polycystic ovarian syndrome (PCOS) in animal models. This systematic review aimed to assess the efficacy and safety of Cangfu Daotan decoction as an adjuvant treatment to Diane-35 for PCOS in humans.

Methods: Seven electronic databases were searched up to June 22, 2024, to identify randomized controlled trials (RCTs) that evaluated Cangfu Daotan decoction combined with Diane-35 versus Diane-35 alone for the treatment of PCOS. The effects of individual RCTs were combined via meta-analysis and were measured as relative risks (RRs) or weighted mean differences (WMDs).

Results: Twenty-five RCTs with a moderate to high risk of bias were included, involving 1845 patients with PCOS. Meta-analyses indicated that compared with Diane-35 alone, the combination of Diane-35 and Cangfu Daotan decoction significantly improved the response rate (RR 1.19, 95 % confidence interval [CI] 1.14 to 1.24), pregnancy rate (RR 1.57, 95 % CI 1.18 to 2.09), ovulation rate (RR 1.22, 95 % CI 1.11 to 1.35), and ovarian volume (WMD -1.43 cm, 95 % CI -2.46 to -0.39). Cangfu Daotan decoction also significantly reduced the luteinizing hormone (LH) level, LH:FSH ratio, testosterone level, prolactin level, body mass index (BMI) and hirsutism and acne scores but had no significant effect on the follicle-stimulating hormone (FSH) level. All adverse events were mild and not related to Cangfu Daotan decoction treatment.

Conclusions: The findings suggest that Cangfu Daotan decoction, as an adjuvant therapy to Diane-35 for the treatment of PCOS, can reduce multiple sex hormone levels and BMI, relieve hyperandrogenism signs, and ultimately improve pregnancy outcomes, with good safety. The effect of Cangfu Daotan decoction on FSH remains uncertain. Due to limitations of risk of bias and heterogeneity, the quality of evidence was rated as moderate to very low.

References

Balen A, Rutherford A . Managing anovulatory infertility and polycystic ovary syndrome. BMJ. 2007; 335(7621):663-6. PMC: 1995495. DOI: 10.1136/bmj.39335.462303.80. View

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

Wu L, Zhang H, Fan M, Yan Y . Efficacy and Safety of Cangfu Daotan Decoction in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2022; 2022:4395612. PMC: 9129968. DOI: 10.1155/2022/4395612. View

Saadia Z . Follicle Stimulating Hormone (LH: FSH) Ratio in Polycystic Ovary Syndrome (PCOS) - Obese vs. Non- Obese Women. Med Arch. 2020; 74(4):289-293. PMC: 7520057. DOI: 10.5455/medarh.2020.74.289-293. View

Zhang F, Ma T, Cui P, Tamadon A, He S, Huo C . Diversity of the Gut Microbiota in Dihydrotestosterone-Induced PCOS Rats and the Pharmacologic Effects of Diane-35, Probiotics, and Berberine. Front Microbiol. 2019; 10:175. PMC: 6375883. DOI: 10.3389/fmicb.2019.00175. View

Yi W, Li X, Chen K, Zhu M, Cai X, Pan A . Effects of Cangfu Daotan Decoction on obese polycystic ovary syndrome and its mechanism. Steroids. 2020; 165:108740. DOI: 10.1016/j.steroids.2020.108740. View

Prelevic G, Wurzburger M, Puzigaca Z . Effects of a low-dose estrogen-antiandrogen combination (Diane-35) on clinical signs of androgenization, hormone profile and ovarian size in patients with polycystic ovary syndrome. Gynecol Endocrinol. 1989; 3(4):269-80. DOI: 10.3109/09513598909152466. View

Palomba S, Santagni S, Falbo A, La Sala G . Complications and challenges associated with polycystic ovary syndrome: current perspectives. Int J Womens Health. 2015; 7:745-63. PMC: 4527566. DOI: 10.2147/IJWH.S70314. View

Neven A, Laven J, Teede H, Boyle J . A Summary on Polycystic Ovary Syndrome: Diagnostic Criteria, Prevalence, Clinical Manifestations, and Management According to the Latest International Guidelines. Semin Reprod Med. 2018; 36(1):5-12. DOI: 10.1055/s-0038-1668085. View

10.

Harper S, Staber P, He X, Eliason S, Martins I, Mao Q . RNA interference improves motor and neuropathological abnormalities in a Huntington's disease mouse model. Proc Natl Acad Sci U S A. 2005; 102(16):5820-5. PMC: 556303. DOI: 10.1073/pnas.0501507102. View

11.

Geisthovel F . A comment on the European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine consensus of the polycystic ovarian syndrome. Reprod Biomed Online. 2004; 7(6):602-5. DOI: 10.1016/s1472-6483(10)62081-0. View

12.

Walter K . What Is Polycystic Ovary Syndrome?. JAMA. 2022; 327(3):294. DOI: 10.1001/jama.2021.19776. View

13.

Feng W, Jia Y, Zhang D, Shi H . Management of polycystic ovarian syndrome with Diane-35 or Diane-35 plus metformin. Gynecol Endocrinol. 2015; 32(2):147-50. DOI: 10.3109/09513590.2015.1101441. View

14.

Marcondes J, Yamashita S, Maciel G, Baracat E, Halpern A . Metformin in normal-weight hirsute women with polycystic ovary syndrome with normal insulin sensitivity. Gynecol Endocrinol. 2007; 23(5):273-8. DOI: 10.1080/09513590701192529. View

15.

Deng A, Li Y, Wu Z, Liu T, Kang L, Nan T . [Advances in studies on chemical compositions of Atractylodes lancea and their biological activities]. Zhongguo Zhong Yao Za Zhi. 2017; 41(21):3904-3913. DOI: 10.4268/cjcmm20162104. View