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Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis.
J Clin Endocrinol Metab. 2018 04 01; 103(4):1258-1264.JC

Abstract

Background

Several pharmacologic treatments for hirsutism are used in practice; however, their relative efficacy is unclear.

Methods

We searched MEDLINE, EMBASE, and CENTRAL through January 2017 for randomized controlled trials (RCTs) with follow-up of at least 6 months that evaluated antiandrogens, insulin sensitizers, and oral contraceptives in women with hirsutism. Independent pairs of reviewers selected and appraised trials. Random-effects network meta-analysis was used to compare individual drugs and classes.

Results

We included 43 trials. Estrogen-progestin oral contraceptives pills (OCPs), antiandrogens, and insulin sensitizers were superior to placebo, with standardized mean reductions (95% confidence intervals) of -0.94 (-1.49 to -0.38), -1.29 (-1.80 to -0.79), and -0.62 (-1.00 to -0.23), respectively. Antiandrogen monotherapy, the combination of OCP and antiandrogen, the combination of OCPs and insulin sensitizer, and the combination of antiandrogen and insulin sensitizer were superior to insulin sensitizer monotherapy. The combination of OCPs and antiandrogen was superior to OCPs. Antiandrogen monotherapy with flutamide, finasteride, and spironolactone were each superior to placebo but similar to each other in efficacy. OCPs containing levonorgestrel, cyproterone acetate, or drospirenone were similar in effectiveness to other OCPs or had trivial differences. The certainty in comparisons with placebo was moderate and for head-to-head comparisons was low.

Conclusions

Estrogen-progestin OCPs, antiandrogens, and insulin sensitizers are superior to placebo for the treatment of hirsutism.

Authors+Show Affiliations

Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota. Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru.Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota. Internal Medicine Department, Saint Joseph Mercy Health System, Ypsilanti, Michigan.Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota. Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri.Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota.Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota. Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota.Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota. Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon.Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota.

Pub Type(s)

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

Language

eng

PubMed ID

29522176

Citation

Barrionuevo, Patricia, et al. "Treatment Options for Hirsutism: a Systematic Review and Network Meta-Analysis." The Journal of Clinical Endocrinology and Metabolism, vol. 103, no. 4, 2018, pp. 1258-1264.
Barrionuevo P, Nabhan M, Altayar O, et al. Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis. J Clin Endocrinol Metab. 2018;103(4):1258-1264.
Barrionuevo, P., Nabhan, M., Altayar, O., Wang, Z., Erwin, P. J., Asi, N., Martin, K. A., & Murad, M. H. (2018). Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis. The Journal of Clinical Endocrinology and Metabolism, 103(4), 1258-1264. https://doi.org/10.1210/jc.2017-02052
Barrionuevo P, et al. Treatment Options for Hirsutism: a Systematic Review and Network Meta-Analysis. J Clin Endocrinol Metab. 2018 04 1;103(4):1258-1264. PubMed PMID: 29522176.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis. AU - Barrionuevo,Patricia, AU - Nabhan,Mohammed, AU - Altayar,Osama, AU - Wang,Zhen, AU - Erwin,Patricia J, AU - Asi,Noor, AU - Martin,Kathryn A, AU - Murad,M Hassan, PY - 2017/09/18/received PY - 2017/09/19/accepted PY - 2018/3/10/pubmed PY - 2018/10/10/medline PY - 2018/3/10/entrez SP - 1258 EP - 1264 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 103 IS - 4 N2 - Background: Several pharmacologic treatments for hirsutism are used in practice; however, their relative efficacy is unclear. Methods: We searched MEDLINE, EMBASE, and CENTRAL through January 2017 for randomized controlled trials (RCTs) with follow-up of at least 6 months that evaluated antiandrogens, insulin sensitizers, and oral contraceptives in women with hirsutism. Independent pairs of reviewers selected and appraised trials. Random-effects network meta-analysis was used to compare individual drugs and classes. Results: We included 43 trials. Estrogen-progestin oral contraceptives pills (OCPs), antiandrogens, and insulin sensitizers were superior to placebo, with standardized mean reductions (95% confidence intervals) of -0.94 (-1.49 to -0.38), -1.29 (-1.80 to -0.79), and -0.62 (-1.00 to -0.23), respectively. Antiandrogen monotherapy, the combination of OCP and antiandrogen, the combination of OCPs and insulin sensitizer, and the combination of antiandrogen and insulin sensitizer were superior to insulin sensitizer monotherapy. The combination of OCPs and antiandrogen was superior to OCPs. Antiandrogen monotherapy with flutamide, finasteride, and spironolactone were each superior to placebo but similar to each other in efficacy. OCPs containing levonorgestrel, cyproterone acetate, or drospirenone were similar in effectiveness to other OCPs or had trivial differences. The certainty in comparisons with placebo was moderate and for head-to-head comparisons was low. Conclusions: Estrogen-progestin OCPs, antiandrogens, and insulin sensitizers are superior to placebo for the treatment of hirsutism. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/29522176/Treatment_Options_for_Hirsutism:_A_Systematic_Review_and_Network_Meta_Analysis_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2017-02052 DB - PRIME DP - Unbound Medicine ER -