Pentoxifylline for women with endometriosis

What is it about?

We reviewed the effectiveness and safety of treating women with known endometriosis with pentoxifylline to find out if it improves pain symptoms and fertility outcomes. Pentoxifylline is an immunomodulator (a substance that has an effect on the immune system) that might offer an alternative approach for treating this condition. We aimed to compare pentoxifylline to no treatment or placebo (dummy treatment), other medical treatment, or surgical treatment. Key results There was not enough evidence to permit any conclusions about the effectiveness and safety of pentoxifylline in terms of fertility and pain relief outcomes in women with endometriosis. No studies reported on the primary outcome of live birth rate or on adverse events (side effects). Pentoxifylline versus placebo We are uncertain as to whether pentoxifylline affects clinical pregnancy rate, recurrence rate of endometriosis, or miscarriage rate when compared with placebo. Data on other outcomes were lacking. Pentoxifylline versus no treatment We are uncertain as to whether pentoxifylline affects overall pain compared to no treatment. Data on other outcomes were lacking. We were unable to extract data from any studies comparing pentoxifylline to other medical therapies, and there were no studies comparing pentoxifylline to surgical treatment. Quality of the evidence The overall quality of evidence was very low. The main limitations in the evidence were lack of intention‐to‐treat analysis (an assessment of all people taking part in a trial, based on the group to which they had initially (and randomly) been allocated to, regardless of whether or not they dropped out, fully adhered to the treatment, or switched to an alternative treatment); lack of blinding (the process where both women participating in the trial and research staff are kept unaware of the treatment used); and imprecision (random error and small size of some studies).

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Why is it important?

Implications for practice With this 2021 update, there continues to be little evidence to support the use of pentoxifylline as a treatment for subfertility or pain management in women with endometriosis. We are unable to comment on the safety of pentoxifylline or its effect on endometriosis‐related symptoms other than pain. In light of the paucity and very low quality of the existing data, particularly for the primary outcomes examined, high‐quality trials are required to definitively determine the impact of pentoxifylline on endometriosis. These trials should not only compare pentoxifylline to no treatment, but also to other proposed alternatives to endometriosis management. Implications for research Future research should prioritise live birth, overall pain, and quality of life as primary outcomes as advocated by a recent international consensus study (Duffy 2020). Studies should include women with all endometriosis severity types. All of the studies included in this review compared pentoxifylline versus placebo or no treatment after surgery, highlighting the need for more types of comparisons, such as pentoxifylline compared with other medical treatments or surgery. Pentoxifylline was administered at a dose of 800 mg/day in all studies, and no other dosage was studied. Furthermore, safety of the intervention should be assessed in greater detail.

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