Intervention Review

Cyproterone acetate for hirsutism

  1. Zephne M van der Spuy1,*,
  2. Paul Andre Le Roux2,
  3. Mushi J Matjila3

Editorial Group: Cochrane Menstrual Disorders and Subfertility Group

Published Online: 20 OCT 2003

Assessed as up-to-date: 16 JUL 2003

DOI: 10.1002/14651858.CD001125


How to Cite

van der Spuy ZM, Le Roux PA, Matjila MJ. Cyproterone acetate for hirsutism. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD001125. DOI: 10.1002/14651858.CD001125.

Author Information

  1. 1

    Groote Schuur Hospital, Department of Obstetrics and Gynaecology, University of Cape Town Medical School, Cape Town, South Africa

  2. 2

    Cape Fertility Clinic, Department of Obstetrics and Gynaecology, Cape Town, South Africa

  3. 3

    Groote Schuur Hospital, Cape Town, South Africa

*Zephne M van der Spuy, Department of Obstetrics and Gynaecology, University of Cape Town Medical School, Groote Schuur Hospital, H Floor, Old Main Building, Observatory, Cape Town, 7925, South Africa. Zephne.VanDerSpuy@uct.ac.za.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 OCT 2003

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

Background

Hirsutism is a distressing and relatively common endocrine problem in women which may prove difficult to manage. Cyproterone acetate, an anti-androgen, is frequently used to treat hirsutism, usually in combination with ethinyl estradiol.

Objectives

The objective of this review was to investigate the effectiveness of cyproterone acetate alone, or in combination with ethinyl estradiol, in reducing hair growth in women with hirsutism secondary to ovarian hyperandrogenism.

Search methods

The Cochrane Menstrual Disorders and Subfertility Group trials register was searched (last search - 4 June 2002). The Cochrane Menstrual Disorders and Subfertility Group register is based on regular searches of MEDLINE (1966 to 2002), EMBASE (1980 to 2002), CINAHL (1982 to 2002), PsycINFO (1987 to 2002) and CENTRAL (Issue 2, 2002 of the Cochrane Library) the handsearching of several journals and conference proceedings, and searches of several key grey literature sources. All publications of randomised controlled trials of cyproterone acetate with or without estrogen versus placebo or other drug therapies for hirsutism were identified.

Selection criteria

All randomised controlled studies comparing:
- cyproterone acetate to placebo
- cyproterone acetate with ethinyl estradiol to placebo
- cyproterone acetate with ethinyl estradiol to cyproterone acetate alone
- cyproterone acetate (with or without estradiol) to other medical therapies for treatment of hirsutism.

Data collection and analysis

Eleven studies were identified which fulfilled the inclusion criteria. Nine randomised studies were included in the review, and two were excluded because of insufficient information. Only one study had more than 100 women included in the analysis. The major outcomes included: subjective improvement in hirsutism, changes in Ferriman Gallwey scores, changes in linear hair growth and hair shaft diameter, alterations in endocrine parameters, side effects to treatment, withdrawals during therapy

Main results

There were no clinical trials comparing cyproterone acetate alone with placebo. There was one small study comparing cyproterone acetate in combination with ethinyl estradiol to placebo. In this study there was a significant subjective reduction in hair growth with cyproterone acetate therapy, although the confidence limits were large. There were no studies comparing cyproterone acetate alone with cyproterone acetate in combination with ethinyl estradiol to treat hirsutism. In studies where cyproterone acetate was compared to other drug modalities (ketoconazole, spironolactone, flutamide, finasteride, GnRH analogues) no difference in clinical outcome was noted. There were, however, endocrinological differences in androgen and estrogen levels between different drug therapies. There were insufficient data to assess differences in side effects between women treated with cyproterone acetate and other medical therapy.

Authors' conclusions

Cyproterone acetate combined with estradiol results in a subjective improvement in hirsutism compared to placebo. Clinical differences in outcome between cyproterone acetate and other medical therapies were not demonstrated in the studies included in this review. This may be because of the small size of the studies, lack of standardized assessment and lack of objective determinants of improvement in hirsutism. The endocrinological effects of the different drug therapies reflect the mode of action. Larger carefully designed studies are needed to compare efficacy and safety profiles between drug therapies for hirsutism.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

Cyproterone acetate appears to be as effective as other medications for hirsutism in women caused by excessive androgen production by the ovaries

One of the causes of hirsutism (excessive hair growth) in women is excessive production of the hormone androgens by the ovaries. A variety of medications can be used to counter the effects of the androgen. Cyproterone acetate is an anti-androgen drug. Adverse effects that have been reported with its use include weight gain, depression, fatigue, breast symptoms and sexual dysfunction. The review of trials found that cyproterone acetate appears to have a similar impact on hirsutism as other drugs used for hirsutism caused by excessive androgen. There was not enough evidence to compare adverse effects of the treatment options.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

治療多毛症的環丙氯地孕酮醋酸酯(Cyproterone acetate)

研究背景

多毛症是一種令婦女煩惱而且不易治療的內分泌問題。環丙氯地孕酮醋酸酯是一種常被用來治療多毛症的抗雄性激素類藥物,常與乙炔雌素二醇(ethinyl estradiol)合併治療。

研究目的

本篇文獻回顧,是針對多毛症婦女卵巢高濃度雄性激素血症所衍生的,去評估單獨使用環丙氯地孕酮醋酸酯、或是將它與乙炔雌素二醇合併使用時,對於毛髮生長抑制的療效。

检索方法

搜尋 Cochrane Menstrual Disorders and Subfertility Group試驗登錄中心 (最後一次搜尋時間為2002年6月4日)。Cochrane Menstrual Disorders and Subfertility Group登錄中心中是以定期更新來自MEDLINE (1966年–2002年)、 EMBASE (1980年–2002年)、 CINAHL (1982年–2002年)、 PsycINFO (1987年–2002年)以及CENTRAL (Issue 2, 2002 of Cochrane Library) 、人工搜尋一些期刊以及研討會手冊,並且搜尋部分重要灰色文獻來源的資料為基礎。找出所有cyproterone acetate 有或沒有estrogen與安慰劑或是其他藥物治療多毛症的隨機對照試驗。

纳入标准

所有的隨機對照研究都比較了下列項目:環丙氯地孕酮醋酸酯相較於安慰劑 環丙氯地孕酮醋酸酯加上乙炔雌素二醇相較於安慰劑 環丙氯地孕酮醋酸酯加上乙炔雌素二醇相較於單獨使用環丙氯地孕酮醋酸酯 環丙氯地孕酮醋酸酯(搭配或不搭配雌素二醇)相較於其他種用來治療多毛症的醫學療法。

数据收集与分析

共確認了11份研究能夠完全符合收集的標準。在本篇回顧當中,共收集了9份隨機化的研究,另外還有2份研究因為資訊不夠充分而被排除在外。只有1份研究在分析當中收集了超過100名的婦女。主要的結果共包括:個人對於多毛症改善的觀感、Ferriman Gallwey評分方面的改變、毛髮直線生長與毛髮軸部直徑等方面的變化、內分泌抽血數據方面的變動、對於治療所產生的副作用,以及在治療期間選擇退出的人數。

主要结果

並沒有任何的臨床試驗將單獨使用環丙氯地孕酮醋酸酯與安慰劑之間進行比較。只有1份研究將環丙氯地孕酮醋酸酯與乙炔雌素二醇搭配使用的方式與安慰劑之間進行比較。在這份研究當中,使用了環丙氯地孕酮醋酸酯之後,雖然說信賴限度(confidence limits)很大,但是個人方面確實可以主觀地感受到毛髮生長明顯地變少了。針對治療多毛症方面,就單獨使用環丙氯地孕酮醋酸酯與環丙氯地孕酮醋酸酯搭配乙炔雌素二醇來使用之間,並沒有任何研究加以比較。在某些研究當中,將環丙氯地孕酮醋酸酯與其他的藥物方式(ketoconazole、 spironolactone、flutamide、finasteride、GnRH的類似物)之間進行比較,並沒有臨床結果方面的差異。然而,在不同的藥物治療方式之間,對於雄性激素與雌性激素的抽血數據比較上,有內分泌方面的差異。對於接受了環丙氯地孕酮醋酸酯治療的婦女們,以及接受其他種醫學治療的婦女們,在這2組之間,我們無法得到充分的資料以用於評估副作用方面的差異。

作者结论

跟安慰劑來比較,環丙氯地孕酮醋酸酯搭配乙炔雌素二醇的治療,能使個人主觀上獲得改善。在環丙氯地孕酮醋酸酯以及其他醫學療法之間,關於結果方面的臨床差異,並沒有在本篇回顧所涵蓋的這些研究當中加以說明。這或許是因為這些研究的規模不夠大、欠缺標準化的評估,而且也欠缺對於多毛症改善方面客觀的評估方法。對於多毛症,還需要有更大型完整設計的研究,來評估各種藥物療法的療效與安全性。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

治療多毛症的環丙氯地孕酮醋酸酯(Cyproterone acetate)

對於因為卵巢製造了過多雄性激素而引起多毛症的婦女來說,環丙氯地孕酮醋酸酯具有與其他藥物相同的功效。多毛症(過多的毛髮生長)的其中一項成因就是卵巢製造了過多的雄性荷爾蒙。有很多的藥物可以用來解決雄性激素所帶來的影響。環丙氯地孕酮醋酸酯就是一種抗雄性激素的藥物。可能的副作用包括了體重增加、憂鬱、疲倦、乳房方面的症狀以及性功能障礙。本篇文獻回顧發現,對於雄性激素過多所引起的多毛症而言,跟其他用於多毛症的藥物比較起來,環丙氯地孕酮醋酸酯具有相似的療效。目前,並沒有足夠的證據比較各種治療方法的副作用。

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