Vilar-González S, Maldonado-Pijuan X, Andrés-García I
Instituto de Medicina Oncológica y Molecular de Asturias, Asturias, España.
Actas Urol Esp. 2010 Oct;34(9):749-57.
Evidence-based medicine is transforming clinical practice because of its progressive implantation.
We considered studying whether LHRH analogues are agents of the same pharmacological class, i.e., whether they have the same clinical effect, using the approach to evidence-based medicine.
PubMed was used as the main source of search. We have reviewed the evidence on the alleged «drug class effect» between analogues and the existing bibliographic support for their use in various medical indications. An evidence level and degree of recommendation have been assigned to each conclusion based on the «Scottish Intercollegiate Guidelines Network».
There are no studies designed to answer the question of a class effect between LHRH analogues or agonists. Reviews and meta-analyses have been performed on many other issues related to therapeutic management either with analogues, alone or in combination with surgery or radiation therapy. Direct comparisons do not allow for obtain definitive conclusions: Indirect evidence is obtained from randomized studies comparing the different LHRH analogues to other treatments used to obtain androgen deprivation. Other issues related to pharmacokinetics and pharmacodynamics supporting either the existence or non-existence of class effect were evaluated.
The current available evidence is not enough to support a presumed «drug class effect» among the various analogues in the treatment of prostate carcinoma.
循证医学因其逐步实施正在改变临床实践。
我们考虑采用循证医学方法研究促黄体生成素释放激素（LHRH）类似物是否属于同一药理学类别，即它们是否具有相同的临床效果。
以PubMed作为主要检索来源。我们回顾了关于类似物之间所谓“药物类别效应”的证据以及它们在各种医学适应症中使用的现有文献支持。根据“苏格兰校际指南网络”为每个结论确定了证据水平和推荐程度。
尚无旨在回答LHRH类似物或激动剂之间类别效应问题的研究。已对许多与单独使用类似物或与手术或放射治疗联合使用的治疗管理相关的其他问题进行了综述和荟萃分析。直接比较无法得出明确结论：间接证据来自将不同LHRH类似物与用于实现雄激素剥夺的其他治疗方法进行比较的随机研究。还评估了与药代动力学和药效学相关的其他支持类别效应存在或不存在的问题。
目前可得的证据不足以支持在前列腺癌治疗中各种类似物之间存在假定的“药物类别效应”。
