A meta-analysis of idiopathic granulomatous mastitis treatments for remission and recurrence prevention

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A meta-analysis of idiopathic granulomatous mastitis treatments for remission and recurrence prevention
Title:
A meta-analysis of idiopathic granulomatous mastitis treatments for remission and recurrence prevention
Journal Title:
Frontiers in Medicine
Keywords:
Publication Date:
30 May 2024
Citation:
Ong, S. S., Ho, P. J., Liow, J. J. K., Tan, Q. T., Goh, S. S. N., Li, J., & Hartman, M. (2024). A meta-analysis of idiopathic granulomatous mastitis treatments for remission and recurrence prevention. Frontiers in Medicine, 11. https://doi.org/10.3389/fmed.2024.1346790
Abstract:
PurposeThe major aim of our meta-analysis was to review the effectiveness of various treatment modalities for achieving successful remission and preventing recurrence for women with idiopathic granulomatous mastitis (IGM). This knowledge is instrumental in developing evidence-based guidelines for clinicians to improve management strategies and outcomes for patients with IGM.MethodsA systematic literature search was performed on MEDLINE (Ovid), Embase (Elsevier), PubMed, Cochrane Library, Web of Science, and Google Scholar; studies published to 19 January 2022 were included. A meta-analysis of 57 observational studies was performed. The results of two randomized controlled trials were also examined.ResultsThere were 3,035 IGM patients across the observational and randomised studies. Overall recurrence and remission rates across all treatment strategies in 59 studies are 87.9% (2,667/3035) and 13.5% (359/2667), respectively. The studies reported 19 different treatment strategies, comprising observation, medical monotherapies, surgery, and combinations involving medical therapies, with and without surgery. Among monotherapy treatment, surgical management had the highest pooled remission rate (0.99 [95% confidence interval (CI) = 0.97–1.00]); among combination therapy, this was steroids and surgery (0.99 [0.94–1.00]). Antibiotic monotherapy had the lowest remission rate (0.72 [0.37–0.96]). The highest recurrence rates belonged to treatments that combined antibiotics and surgery (0.54 [0.02–1.00]), and antibiotics, steroids, and surgery (0.57 [0.00–1.00]). Most successful for preventing recurrence were observation (0.03 [0.00–0.10]), methotrexate (0.08 [0.00–0.24]), and steroids and surgery (0.05 [0.01–0.12]). There is a significant association between longer follow-up duration and recurrence rate reported, p = 0.002.ConclusionCombination therapies, especially those incorporating antibiotics, steroids, and surgery, have demonstrated higher remission rates, challenging the use of antibiotic monotherapy. There is an increased emphasis on the need for personalised, multi-pronged approach for preventing IGM recurrence, with longer follow-up care. More prospective future work in IGM research, with standardised diagnostic criteria, treatment protocols, and reporting guidelines will be important for developing treatment protocols and guidelines clinicians can adhere to in the clinical management of IGM patients.Systematic review registration: PROSPERO (CRD42022301386).
License type:
Attribution 4.0 International (CC BY 4.0)
Funding Info:
This research / project is supported by the National University Health System (NUHS) - Seed Fund Grant 2019
Grant Reference no. : NUHSRO/2020/027/T1/Seed-Aug/11

This research / project is supported by the Saw Swee Hock School of Public Health - Breast Cancer Prevention Programme
Grant Reference no. : SSHSPH-Res-Prog-BCPP

This research / project is supported by the Yong Loo Lin School of Medicine - Breast Cancer Screening and Prevention Programme
Grant Reference no. : NUHSRO/2020/121/BCSPP/LOA

This research is supported by core funding from: Agency for Science, Technology and Research (A*STAR)
Grant Reference no. : N.A.
Description:
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
ISSN:
2296-858X