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Clinical review: Antiandrogens for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials.
J Clin Endocrinol Metab. 2008 Apr; 93(4):1153-60.JC

Abstract

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.

Authors+Show Affiliations

Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

18252786

Citation

Swiglo, Brian A., et al. "Clinical Review: Antiandrogens for the Treatment of Hirsutism: a Systematic Review and Metaanalyses of Randomized Controlled Trials." The Journal of Clinical Endocrinology and Metabolism, vol. 93, no. 4, 2008, pp. 1153-60.
Swiglo BA, Cosma M, Flynn DN, et al. Clinical review: Antiandrogens for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials. J Clin Endocrinol Metab. 2008;93(4):1153-60.
Swiglo, B. A., Cosma, M., Flynn, D. N., Kurtz, D. M., Labella, M. L., Mullan, R. J., Erwin, P. J., & Montori, V. M. (2008). Clinical review: Antiandrogens for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials. The Journal of Clinical Endocrinology and Metabolism, 93(4), 1153-60. https://doi.org/10.1210/jc.2007-2430
Swiglo BA, et al. Clinical Review: Antiandrogens for the Treatment of Hirsutism: a Systematic Review and Metaanalyses of Randomized Controlled Trials. J Clin Endocrinol Metab. 2008;93(4):1153-60. PubMed PMID: 18252786.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical review: Antiandrogens for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials. AU - Swiglo,Brian A, AU - Cosma,Mihaela, AU - Flynn,David N, AU - Kurtz,David M, AU - Labella,Matthew L, AU - Mullan,Rebecca J, AU - Erwin,Patricia J, AU - Montori,Victor M, Y1 - 2008/02/05/ PY - 2008/2/7/pubmed PY - 2008/5/28/medline PY - 2008/2/7/entrez SP - 1153 EP - 60 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 93 IS - 4 N2 - 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. SN - 0021-972X UR - https://www.unboundmedicine.com/medline/citation/18252786/Clinical_review:_Antiandrogens_for_the_treatment_of_hirsutism:_a_systematic_review_and_metaanalyses_of_randomized_controlled_trials_ DB - PRIME DP - Unbound Medicine ER -