Antiandrogens for the Treatment of Hirsutism: A Systematic Review and Metaanalyses of Randomized Controlled Trials

@article{citeulike:2697227, 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), 2.35.4; inconsistency (I2) = 0\%]. When compared with metformin, spironolactone reduced hirsutism scores by 1.3 (CI, 0.032.6) and flutamide by 5.0 (CI, 3.07.0; I2 = 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, 0.13.3; I2 = 0\%) or flutamide with metformin (4.6; CI, 1.37.9; I2 = 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. 10.1210/jc.2007-2430}, author = {Swiglo, Brian A. and Cosma, Mihaela and Flynn, David N. and Kurtz, David M. and Labella, Matthew L. and Mullan, Rebecca J. and Erwin, Patricia J. and Montori, Victor M. }, citeulike-article-id = {2697227}, doi = {10.1210/jc.2007-2430}, journal = {J Clin Endocrinol Metab}, keywords = {hirsutism, meta-analysis, therapy}, month = {April}, number = {4}, pages = {1153--1160}, posted-at = {2008-04-21 18:05:00}, priority = {2}, title = {Antiandrogens for the Treatment of Hirsutism: A Systematic Review and Metaanalyses of Randomized Controlled Trials}, url = {http://dx.doi.org/10.1210/jc.2007-2430}, volume = {93}, year = {2008} }

TY - JOUR ID - citeulike:2697227 TI - Antiandrogens for the Treatment of Hirsutism: A Systematic Review and Metaanalyses of Randomized Controlled Trials JF - J Clin Endocrinol Metab VL - 93 IS - 4 SP - 1153 EP - 1160 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), 2.35.4; inconsistency (I2) = 0%]. When compared with metformin, spironolactone reduced hirsutism scores by 1.3 (CI, 0.032.6) and flutamide by 5.0 (CI, 3.07.0; I2 = 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, 0.13.3; I2 = 0%) or flutamide with metformin (4.6; CI, 1.37.9; I2 = 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. 10.1210/jc.2007-2430 KW - hirsutism KW - meta-analysis KW - therapy AU - Swiglo, Brian AU - Cosma, Mihaela AU - Flynn, David AU - Kurtz, David AU - Labella, Matthew AU - Mullan, Rebecca AU - Erwin, Patricia AU - Montori, Victor PY - 2008/04/01/ UR - http://dx.doi.org/10.1210/jc.2007-2430 ER -