Comparative effectiveness of Korean medicine treatment for idiopathic central precocious puberty: A Bayesian network meta-analysis

Background: The purpose of this study is to analyze the comparative effect of the Korean medicine treatment for idiopathic central precocious puberty (ICPP) using Bayesian network meta-analysis (NMA).

Methods: Seventeen electronic databases were used to search for randomized controlled trials (RCTs) that evaluated various Korean medicine treatments for ICPP. R software (version 4.2.3) was used to perform NMA. The risk of bias was assessed using the Risk of Bias 2 tool proposed by the Cochrane Collaboration. The results of NMA were expressed as network map, SUCRA, and Rank plot.

Results: A total of 81 RCTs were included in the NMA. The gonadotropin-releasing hormone agonist (GnRHa) was the most effective for growth rate, followed by herbal medicine (HM) combined with GnRHa. The combination of HM and auricular plaster therapy was the most effective in improving the bone age index and ovarian volume, and megestrol was the most effective in improving uterine volume. The combination of HM, auricular plaster therapy and GnRHa was the most effective in improving follicle-stimulating hormone, and the combination of HM and GnRHa was the most effective in improving luteinizing hormone and estradiol.

Conclusion: The combination of HM and GnRHa generally showed greater effectiveness compared to GnRHa monotherapy or HM monotherapy. Although there have been few reports of adverse events related to HM, additional research and practical experience are needed. Further diverse studies should be conducted to support the decision-making process of patients and clinicians during the diagnosis and treatment of ICPP.