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Aromatasehemmer zur ovariellen Stimulation bei subfertilen Frauen mit Syndrom der polyzystischen Ovarien

Zusammenfassung einer Cochrane-Metaanalyse

Aromatase inhibitors for ovarian stimulation in subfertile women with polycystic ovary syndrome

Summary of a Cochrane meta-analysis

  • Gynäkologie aktuell
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Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Das Syndrom der polyzystischen Ovarien (PCOS) ist eine der häufigsten Ursachen für Zyklusstörungen und anovulatorische Subfertilität. Ziel dieser Metaanalyse war, die Effektivität und Sicherheit von Aromatasehemmern mit anderen Medikamenten für ovarielle Hyperstimulation bei subfertilen Frauen mit PCOS zu vergleichen.

Methoden

Dazu erfolgte eine Literaturrecherche nach entsprechenden randomisierten kontrollierten Studien (RCT). Primäre Endpunkte waren Lebendgeburten und ovarielles Hyperstimulationssyndrom (OHSS). Sekundäre Endpunkte waren klinische Schwangerschaftsrate, Fehlgeburtsrate und multiple Schwangerschaftsrate.

Ergebnisse

Der Aromatasehemmer Letrozol wurde in allen 42 analysierten RCT mit 7935 Teilnehmerinnen verwendet, in 25 RCT im Vergleich mit Clomiphen. Die statistische Analyse ergab bei Lebendgeburten einen deutlichen Vorteil für Letrozol gegenüber Clomiphen (Odds Ratio, OR: 1,68; 95%-KI: 1,42–1,99; Teilnehmerinnen = 2954; Studien = 14; I2 = 0 %; „number needed to treat“, NNT = 10; moderate Beweisqualität). Es gab keinen Anhalt für eine Risikodifferenz (RD) für das OHSS (RD −0,00, 95%-KI: −0,01 bis 0,00; Teilnehmerinnen = 2536; Studien = 12; I2 = 0 %; hohe Beweisqualität). Ein deutlicher Vorteil für das Auftreten von klinischen Schwangerschaften zeigte sich für Letrozol (OR: 1,56; 95%-KI: 1,37–1,78; Teilnehmerinnen = 4629; Studien = 25; I2 = 1 %, NNT = 10; moderate Beweisqualität). Es gab keinen Anhalt einer Differenz für das Auftreten von Fehlgeburten (OR: 0,94; 95%-KI: 0,70–1,26; Teilnehmerinnen = 1210; Studien = 18; I2 = 0 %; hohe Beweisqualität) oder Mehrlingsschwangerschaften (OR: 0,69; 95%-KI: 0,41–1,16; Teilnehmerinnen = 3579; Studien = 17; I2 = 0 %; hohe Beweisqualität).

Schlussfolgerung

Letrozol zeigt verglichen mit Clomiphen eine deutlich erhöhte Rate an Lebendgeburten und klinischen Schwangerschaften. Die Beweisqualität der Analyse ist hoch bis moderat. Die OHSS-Inzidenz war in beiden Gruppen gleich.

Abstract

Background

Polycystic ovary syndrome (PCOS) is the most common cause of infrequent periods (oligomenorrhoea) and absence of periods (amenorrhoea), often leading to subfertlity. The aim of this meta-analysis was to compare the effectiveness and safety of aromatase inhibitors with other medical therapies for ovulation induction in subfertile women with PCOS.

Methods

An extensive systematic literature search was done to identify relevant randomized controlled trials (RCTs). The primary outcomes were live birth and ovarian hyperstimulation syndrome (OHSS). Secondary endpoints were pregnancy rate, miscarriage rate, and multiple pregnancy rate.

Results

A total of 42 RCTs (7935 women) in which the aromatase inhibitor letrozole was used were included. In 25 RCTs, comparisons were also made to clomiphene citrate. Live birth rates were higher with letrozole compared to clomiphene citrate (odds ratio [OR] 1.68, 95% CI 1.42–1.99; 2954 participants; 13 studies; I2 = 0%; number needed to treat for an additional beneficial outcome [NNTB] = 10; moderate-quality evidence). There is high-quality evidence that OHSS rates are similar with letrozole and clomiphene citrate (0.5% in both arms: risk difference [RD] −0.00, 95% CI −0.01 to 0.00; 2536 participants; 12 studies; I2 = 0%; high-quality evidence). There is evidence for a higher pregnancy rate in favor of letrozole (OR 1.56, 95% CI 1.37–1.78; 4629 participants; 25 studies; I2 = 1%; NNTB = 10; moderate-quality evidence). There is little or no difference between treatment groups in the rate of miscarriage (OR 0.94, 95% CI 0.70–1.26; 1210 participants; 18 studies; I2 = 0%; high-quality evidence) and multiple pregnancy rate (OR 0.69, 95% CI 0.41–1.16; 3579 participants; 17 studies; I2 = 0%; high-quality evidence).

Conclusion

Compared to clomiphene citrate, letrozole shows a significantly increased rate of live births and pregnancies. The quality of evidence of the analysis is high to moderate. The incidence of OHSS was the same in both groups-

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Authors and Affiliations

  1. Frauenheilkunde und Geburtshilfe, Universitätsklinikum Münster, Münster, Deutschland

    Sebastian Franik, Quang-Koi Le, Stephanie Eltrop & Ludwig Kiesel

  2. Department of Obstetrics and Gynaecology, Auckland, Neuseeland

    Cynthia Farquhar

  3. Facharztpraxis für Frauenheilkunde und Geburtshilfe, Hagsche Straße 52, 47533, Kleve, Deutschland

    Sebastian Franik

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  1. Sebastian Franik
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Correspondence to Sebastian Franik.

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Interessenkonflikt

S. Franik, Q.-K. Le, S. Eltrop, C. Farquhar und L. Kiesel geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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T. Fehm, Düsseldorf

L. Kiesel, Münster

R. Kimmig, Essen

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Franik, S., Le, QK., Eltrop, S. et al. Aromatasehemmer zur ovariellen Stimulation bei subfertilen Frauen mit Syndrom der polyzystischen Ovarien. Gynäkologe 53, 841–846 (2020). https://doi.org/10.1007/s00129-020-04705-0

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