Li Binting, Xu Xiaotong, Xu Keyi, Ni Jing, Wang Cong, Zhang Ting
The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China.
Zhejiang Chinese Medical University, Hangzhou, China.
Arch Gynecol Obstet. 2025 May 20. doi: 10.1007/s00404-025-08050-2.
This systematic review and network meta-analysis (NMA) compares four progestins-gestodene (GSD), desogestrel (DSG), drospirenone (DRSP), and levonorgestrel (LNG)-in combined oral contraceptives (COCs) regarding safety, and efficacy for personalized contraceptive selection.
This systematic review, which searched PubMed, Cochrane, Embase and Medline through Jan 28, 2025, to identify published and unpublished randomised controlled trials (RCTs). We assessed the certainty of evidence using the confidence in network meta-analysis (CINeMA) framework. We estimated summary standardised mean differences (SMDs) and odds ratios (ORs) using NMA with random effects by STATA and GeMTC software. The outcomes included breakthrough bleeding (BTB), irregular bleeding (IB), withdrawal bleeding days, pregnancy rates, and adverse events.
Eighteen RCTs were included. GSD demonstrated the lowest incidence of BTB and IB (OR 0.41 (0.26, 0.66); OR 0.67 (0.52, 0.86)). For withdrawal bleeding days, DRSP ranked highest (SUCRA 40.1; I = 27%, p = 0.222), followed by GSD, LNG and DSG. Contraceptive efficacy was highest for DSG (OR 0.74, (0.31-1.73); SUCRA = 51.3%) followed by DRSP and GSD, with LNG being the least effective. Regarding safety, DRSP had the lowest adverse event rate (OR 0.84, 0.60-1.19); SUCRA = 66.9%), followed by LNG and DSG, while GSD was associated with the highest.
The four progestogens demonstrate comparable contraceptive efficacy while exhibiting distinct therapeutic advantages in their respective clinical applications. DSG for routine use, GSD for bleeding control, DRSP for minimizing androgenic effects, and LNG for emergency contraception.
PROSPERO ID: CRD42024582991.
本系统评价和网状Meta分析（NMA）比较了复方口服避孕药（COC）中四种孕激素——孕二烯酮（GSD）、去氧孕烯（DSG）、屈螺酮（DRSP）和左炔诺孕酮（LNG）在安全性和有效性方面的差异，以指导个性化避孕选择。
本系统评价通过检索截至2025年1月28日的PubMed、Cochrane、Embase和Medline数据库，以识别已发表和未发表的随机对照试验（RCT）。我们使用网状Meta分析置信度（CINeMA）框架评估证据的确定性。我们使用STATA和GeMTC软件通过NMA随机效应模型估计汇总标准化均数差（SMD）和比值比（OR）。结局指标包括突破性出血（BTB）、不规则出血（IB）、撤退性出血天数、妊娠率和不良事件。
纳入18项RCT。GSD的BTB和IB发生率最低（OR 0.41（0.26，0.66）；OR 0.67（0.52，0.86））。对于撤退性出血天数，DRSP排名最高（累积排序曲线下面积（SUCRA）为40.1；I=27%，p=0.222），其次是GSD、LNG和DSG。DSG的避孕效果最高（OR 0.74，（0.31 - 1.73）；SUCRA=51.3%），其次是DRSP和GSD，LNG效果最差。在安全性方面，DRSP的不良事件发生率最低（OR 0.84，0.60 - 1.19；SUCRA=66.9%），其次是LNG和DSG，而GSD相关不良事件发生率最高。
这四种孕激素具有相当的避孕效果，但在各自的临床应用中表现出不同的治疗优势。DSG用于常规避孕，GSD用于控制出血，DRSP用于最小化雄激素效应，LNG用于紧急避孕。
PROSPERO注册号：CRD42024582991。
