title: Pentoxifylline for endometriosis.
abstract: BACKGROUND
  Endometriosis is a chronic, recurring condition that occurs during the reproductive years. It is characterized by endometrial tissue developing outside the uterine cavity. This endometrial tissue development is dependent on oestrogen produced primarily by the ovaries and, therefore, traditional management has focused on ovarian suppression. In this review we considered the role of modulation of the immune system as an alternative approach. This is an update of a Cochrane Review previously published in 2009 (Lu 2009).
  
  
  OBJECTIVE
  To assess the effects of pentoxifylline, which has anti-inflammatory effects, in subfertile, premenopausal women for the management of endometriosis.
  
  
  METHODS
  For the first publication of this review we searched the following databases (from inception to December 2008) for trials: Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and PsycINFO. In addition, all reference lists of included trials were searched and experts in the field were contacted in an attempt to locate trials. This search was rerun to 23 November 2011, for this update.
  
  
  METHODS
  Randomised controlled trials (RCTs) comparing pentoxifylline with placebo or no treatment, medical treatment, or surgery in subfertile, premenopausal women were included.
  
  
  METHODS
  Two review authors independently selected trials for inclusion, assessed trial risk of bias, and extracted data using data extraction forms. We contacted study authors for additional information and data. The domains assessed for risk of bias were sequence generation, allocation concealment, blinding, incomplete outcome data, and selective outcome reporting. Peto odds ratios (OR) were used for reporting dichotomous data with 95% confidence intervals (CI), whilst mean differences (MD) were expressed for continuous data. Statistical heterogeneity was assessed using the I(2) statistic.
  
  
  RESULTS
  Four trials involving 334 participants were included. One RCT [n=34] showed pentoxifylline had no significant effect on reduction in pain (MD -1.60, 95% CI -3.32 to 0.12). There was no evidence of an increase in clinical pregnancy events in the pentoxifylline group compared with placebo (three RCTs [n=67] OR 1.54, 95% CI 0.89 to 266). One RCT studied recurrence of endometriosis [n=88] (OR 0.88,95% CI 0.27 to 2.84). No trials reported the effects of pentoxifylline on the odds of live birth rate per woman, improvement of endometriosis-related symptoms, or adverse events.
  
  
  CONCLUSIONS
  This review has been updated in 2011. The results of the original review published in 2009 remain unchanged. There is still not enough evidence to support the use of pentoxifylline in the management of premenopausal women with endometriosis in terms of subfertility and relief of pain outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
authors.forename: Donghao
authors.initials: D
authors.lastname: Lu
authors.forename: Huan
authors.initials: H
authors.lastname: Song
authors.forename: Yalun
authors.initials: Y
authors.lastname: Li
authors.forename: Jane
authors.initials: J
authors.lastname: Clarke
authors.forename: Gang
authors.initials: G
authors.lastname: Shi
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000276:immunology / Q000627:therapeutic use*; D002908:Chronic Disease; D004715:Endometriosis / Q000188:drug therapy* / Q000276:immunology / Q000601:surgery; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000276:immunology / Q000627:therapeutic use*; D007247:Infertility, Female / Q000188:drug therapy* / Q000276:immunology / Q000601:surgery; D010146:Pain / Q000188:drug therapy; D010431:Pentoxifylline / Q000276:immunology / Q000627:therapeutic use*; D011247:Pregnancy; D018873:Pregnancy Rate; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007155:Immunologic Factors; D010431:Pentoxifylline