Antiandrogens for the treatment of hirsutism: A systematic review and metaanalyses of randomized controlled trials

被引:85
作者
Swiglo, Brian A. [1 ,2 ]
Cosma, Mihaela [1 ,2 ]
Flynn, David N. [1 ]
Kurtz, David M. [1 ]
LaBella, Matthew L. [1 ]
Mullan, Rebecca J. [1 ]
Erwin, Patricia J. [1 ,3 ,4 ]
Montori, Victor M. [1 ,2 ]
机构
[1] Mayo Clin, Coll Med, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
[2] Mayo Clin, Coll Med, Div Endocrinol Diabet Metab & Nutr, Rochester, MN 55905 USA
[3] Mayo Clin, Coll Med, Dept Med, Rochester, MN 55905 USA
[4] Mayo Clin, Coll Med, Mayo Clin Lib, Rochester, MN 55905 USA
关键词
D O I
10.1210/jc.2007-2430
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: The relative efficacy of antiandrogens for the treatment of hirsutism remains unclear. Objective: We performed a systematic review and metaanalyses of randomized controlled trials (RCTs) evaluating the effect of antiandrogens on hirsutism. Data Sources: We used librarian-designed search strategies for MEDLINE, EMBASE, and Cochrane CENTRAL (up to May 2006), review of reference lists, and contact with hirsutism experts to identify eligible RCTs. Study Selection: Eligible studies were RCTs of at least 6 months of antiandrogen use in women with hirsutism. Reviewers, with acceptable chance-adjusted agreement (kappa = 0.72), independently assessed eligibility. Data Extraction: Reviewers used structured forms to assess and collect methodological quality (allocation concealment, blinding, and loss to follow-up) and study data. Data Synthesis: Of 348 candidate studies, 12 were eligible (18 comparisons). Their methodological quality was low. Random-effects metaanalyses showed that compared with placebo, antiandrogens reduce Ferriman-Gallwey scores by 3.9 [95% confidence interval (CI), 2.3-5.4; inconsistency (I-2) = 0%]. When compared with metformin, spironolactone reduced hirsutism scores by 1.3 (CI, 0.03-2.6) and flutamide by 5.0 (CI, 3.0-7.0; I-2 = 0%). For these interventions, two to five women need to receive treatment for one to notice improvement. Spironolactone or finasteride in combination with contraceptives (1.7; CI, 0.1-3.3; I-2 = 0%) or flutamide with metformin (4.6; CI, 1.3-7.9; I-2 = 40%) appear superior to monotherapy with contraceptives and metformin, respectively. Only three RCTs reported patient self-assessments of hirsutism. Conclusions: Weak evidence suggests antiandrogens are mildly effective agents for the treatment of hirsutism.
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页码:1153 / 1160
页数:8
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