Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis

Murad, M. Hassan; Altayar, Osama; Wang, Zhen; Nabhan, Mohammed; Asi, Noor; Erwin, Patricia J.; Barrionuevo, Patricia; Martin, Kathryn A.

dc.contributor.author	Barrionuevo, Patricia
dc.contributor.author	Nabhan, Mohammed
dc.contributor.author	Altayar, Osama
dc.contributor.author	Wang, Zhen
dc.contributor.author	Erwin, Patricia J.
dc.contributor.author	Asi, Noor
dc.contributor.author	Martin, Kathryn A.
dc.contributor.author	Murad, M. Hassan
dc.date.accessioned	2018-12-03T17:02:35Z
dc.date.available	2018-12-03T17:02:35Z
dc.date.issued	2018
dc.identifier.uri	https://hdl.handle.net/20.500.12866/4268
dc.description.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.	en_US
dc.language.iso	eng
dc.publisher	Oxford University Press
dc.relation.ispartofseries	Journal of Clinical Endocrinology and Metabolism
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.rights.uri	https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject	Female	en_US
dc.subject	Humans	en_US
dc.subject	Drug Therapy, Combination	en_US
dc.subject	Androgen Antagonists	en_US
dc.subject	Contraceptives, Oral, Combined	en_US
dc.subject	Hirsutism	en_US
dc.subject	Hypoglycemic Agents	en_US
dc.subject	Insulin Resistance	en_US
dc.subject	Randomized Controlled Trials as Topic	en_US
dc.title	Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.1210/jc.2017-02052
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.18
dc.relation.issn	1945-7197