Comment: The quality of evidence is downgraded by study quality and by imprecise results (few patients).
A Cochrane review [Abstract] 1 assessed different medical treatments for hirsutism. Flutamide 250 mg b.i.d. was more effective than placebo in reducing Ferriman-Gallwey scores (score 0 to 36) (MD -7.60, 95% CI -10.53 to -4.67 in one and MD -7.20, 95% CI -10.15 to -4.25 in the other study). Spironolactone showed similar effectiveness to flutamide in 2 studies (MD -1.90, 95% CI -5.01 to 1.21 and MD 0.49, 95% CI -1.99 to 2.97). There was no clear difference compared to metformin in 3 studies, but the results were inconsistent.
A meta-analysis 2 assessing treatment options for hirsutism included 43 trials. Antiandrogen monotherapy with flutamide, finasteride, and spironolactone were each superior to placebo but similar to each other in efficacy.
Another meta-analysis 3 included 13 studies (n = 961). Seven studies had a high risk of bias, 9 moderate and 4 low. Anti-androgens included were finasteride, flutamide, spironolactone, or bicalutamide. For hirsutism anti-androgens + lifestyle were superior to metformin + lifestyle (weighted mean difference [WMD] -1.59, 95% CI -3.06 to -0.12, I²=74) but were not superior to placebo + lifestyle (WMD -0.93, 95% CI -3.37 to 1.51; I²=76%). Daily use was more effective than use every three days, and resulted in lower androstenedione levels. There were no differences in hirsutism when anti-androgens + metformin + lifestyle were compared with either anti-androgens + lifestyle or metformin + lifestyle.
Date of latest search: 11 June 2014
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