Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.
Monash Centre for Health Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3800, Australia.
Eur J Endocrinol. 2023 Jul 20;189(1):S1-S16. doi: 10.1093/ejendo/lvad082.
To compare between different combined oral contraceptive pills (COCPs) as part of the update of the International Evidence-Based Guidelines on the Assessment and Management of polycystic ovary syndrome (PCOS).
A systematic review and meta-analysis was performed, Prospero CRD42022345640.
MEDLINE, EMBASE, All EBM, CINAHL, and PsycINFO was searched on July, 8, 2022, for studies including women with PCOS, comparing 2 different COCPs in randomized controlled trials.
A total of 1660 studies were identified, and 19 randomized controlled trials (RCTs) were included.Fourth-generation COCP resulted in lower body mass index (BMI) (mean difference [MD] 1.17 kg/m2 [95% confidence interval {CI} 0.33; 2.02]) and testosterone (MD 0.60 nmol/L [95% CI 0.13; 1.07]) compared with third-generation agents, but no difference was seen in hirsutism.Ethinyl estradiol (EE)/cyproterone acetate (CPA) was better in reducing hirsutism as well as biochemical hyperandrogenism (testosterone [MD 0.38 nmol/L {95% CI 0.33-0.43}]) and BMI (MD 0.62 kg/m2 [95% CI 0.05-1.20]) compared with conventional COCPs.There was no difference in hirsutism between high and low EE doses. No evidence regarding natural estrogens in COCP was identified.
With current evidence, combined regimens containing an antiandrogen (EE/CPA) may be better compared with conventional COCPs in reducing hyperandrogenism, but EE/CPA will not be recommended as a first-line COCP treatment by the pending PCOS guideline update, due to higher venous thrombotic events (VTE) risk in the general population. Later-generation progestins offer theoretical benefits, but better evidence on clinical outcomes is needed in women with PCOS.
The protocol for the systematic review was registered prospectively in Prospero, CRD42022345640.
作为多囊卵巢综合征（PCOS）评估和管理国际循证指南更新的一部分，对不同的复方口服避孕药（COCP）进行比较。
进行了系统评价和荟萃分析，Prospéro CRD42022345640。
于 2022 年 7 月 8 日在 MEDLINE、EMBASE、All EBM、CINAHL 和 PsycINFO 上检索了包括 PCOS 女性在内的比较随机对照试验中 2 种不同 COCP 的研究。
共确定了 1660 项研究，纳入了 19 项随机对照试验（RCT）。与第三代药物相比，第四代 COCP 可降低体重指数（BMI）（平均差值 [MD] 1.17kg/m2[95%置信区间{CI}0.33;2.02]）和睾酮（MD 0.60nmol/L[95%CI0.13;1.07]），但在多毛症方面无差异。乙炔雌二醇（EE）/环丙孕酮（CPA）在降低多毛症以及生化高雄激素血症（睾酮[MD 0.38nmol/L{95%CI0.33-0.43}]）和 BMI（MD 0.62kg/m2[95%CI0.05-1.20]）方面优于传统 COCP。高 EE 剂量和低 EE 剂量之间的多毛症无差异。没有发现 COCP 中天然雌激素的证据。
根据目前的证据，含有抗雄激素（EE/CPA）的联合方案在降低高雄激素血症方面可能优于传统 COCP，但由于普通人群中静脉血栓栓塞事件（VTE）风险增加，EE/CPA 不会被推荐为 PCOS 待更新指南的一线 COCP 治疗方法。新一代孕激素具有理论上的优势，但需要在 PCOS 女性中获得关于临床结局的更好证据。
系统评价的方案前瞻性地在 Prospéro 中注册，CRD42022345640。
