Cyproterone acetate for hirsutism

Zephne M van der Spuy; Paul Andre Le Roux; Mushi J Matjila

doi:10.1002/14651858.CD001125

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Analysis 2.1

Comparison 2 CPA (2MG) + EE versus PLACEBO, Outcome 1 SUBJECTIVE IMPROVEMENT IN HAIR GROWTH.

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Analysis 3.1

Comparison 3 CPA (>2MG) + EE versus CPA(2MG) + EE, Outcome 1 FERRIMAN GALLWEY AT 6 MONTHS.

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Analysis 3.2

Comparison 3 CPA (>2MG) + EE versus CPA(2MG) + EE, Outcome 2 TESTOSTERONE (TOTAL) AT 6 MONTHS.

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Analysis 3.3

Comparison 3 CPA (>2MG) + EE versus CPA(2MG) + EE, Outcome 3 TESTOSTERONE LEVEL (FREE) AT 6 MONTHS.

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Analysis 3.4

Comparison 3 CPA (>2MG) + EE versus CPA(2MG) + EE, Outcome 4 ANDROSTENEDIONE LEVEL AT 6 MONTHS.

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Analysis 3.5

Comparison 3 CPA (>2MG) + EE versus CPA(2MG) + EE, Outcome 5 DHEAS LEVEL AT 6 MONTHS.

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Analysis 3.6

Comparison 3 CPA (>2MG) + EE versus CPA(2MG) + EE, Outcome 6 ESTRADIOL LEVEL AT 6 MONTHS.

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Analysis 4.1

Comparison 4 CPA versus KETOCONAZOLE, Outcome 1 FERRIMAN GALLWEY AT 6 MONTHS.

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Analysis 4.2

Comparison 4 CPA versus KETOCONAZOLE, Outcome 2 TESTOSTERONE (TOTAL) AT 6 MONTHS.

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Analysis 4.3

Comparison 4 CPA versus KETOCONAZOLE, Outcome 3 TESTOSTERONE (FREE) AT 6 MONTHS.

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Analysis 4.4

Comparison 4 CPA versus KETOCONAZOLE, Outcome 4 ANDROSTENEDIONE AT 6 MONTHS.

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Analysis 4.5

Comparison 4 CPA versus KETOCONAZOLE, Outcome 5 DHEAS AT 6 MONTHS.

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Analysis 4.6

Comparison 4 CPA versus KETOCONAZOLE, Outcome 6 ESTRADIOL AT 6 MONTHS.

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Analysis 5.1

Comparison 5 CPA versus SPIRONOLACTONE, Outcome 1 WITHDRAWALS DURING TREATMENT.

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Analysis 5.2

Comparison 5 CPA versus SPIRONOLACTONE, Outcome 2 FERRIMAN GALLWEY AT 3 MONTHS.

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Analysis 5.3

Comparison 5 CPA versus SPIRONOLACTONE, Outcome 3 FERRIMAN GALLWEY AT 6 MONTHS.

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Analysis 5.4

Comparison 5 CPA versus SPIRONOLACTONE, Outcome 4 SIDE EFFECTS DURING TREATMENT.

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Analysis 5.5

Comparison 5 CPA versus SPIRONOLACTONE, Outcome 5 LINEAR HAIR GROWTH AT 3 MONTHS.

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Analysis 5.6

Comparison 5 CPA versus SPIRONOLACTONE, Outcome 6 LINEAR HAIR GROWTH AT 6 MONTHS.

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Analysis 5.7

Comparison 5 CPA versus SPIRONOLACTONE, Outcome 7 HAIR SHAFT DIAMETER AT 6 MONTHS.

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Analysis 5.8

Comparison 5 CPA versus SPIRONOLACTONE, Outcome 8 TESTOSTERONE (TOTAL) AT 6 MONTHS.

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Analysis 5.9

Comparison 5 CPA versus SPIRONOLACTONE, Outcome 9 TESTOSTERONE (FREE) AT 6 MONTHS.

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Analysis 5.10

Comparison 5 CPA versus SPIRONOLACTONE, Outcome 10 ANDROSTENEDIONE AT 6 MONTHS.

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Analysis 5.11

Comparison 5 CPA versus SPIRONOLACTONE, Outcome 11 DHEAS AT 6 MONTHS.

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Analysis 5.12

Comparison 5 CPA versus SPIRONOLACTONE, Outcome 12 SHBG AT 6 MONTHS.

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Analysis 5.13

Comparison 5 CPA versus SPIRONOLACTONE, Outcome 13 ESTRADIOL AT 6 MONTHS.

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Analysis 6.1

Comparison 6 CPA versus FLUTAMIDE, Outcome 1 WITHDRAWALS FROM TREATMENT.

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Analysis 6.2

Comparison 6 CPA versus FLUTAMIDE, Outcome 2 FERRIMAN GALLWEY AT 3 MONTHS.

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Analysis 6.3

Comparison 6 CPA versus FLUTAMIDE, Outcome 3 FERRIMAN GALLWEY AT 6 MONTHS.

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Analysis 6.4

Comparison 6 CPA versus FLUTAMIDE, Outcome 4 FERRIMAN GALLWEY AT 12 MONTHS.

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Analysis 6.5

Comparison 6 CPA versus FLUTAMIDE, Outcome 5 SIDE EFFECTS.

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Analysis 6.6

Comparison 6 CPA versus FLUTAMIDE, Outcome 6 TESTOSTERONE (TOTAL) AT 3 MONTHS.

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Analysis 6.7

Comparison 6 CPA versus FLUTAMIDE, Outcome 7 TESTOSTERONE (TOTAL) AT 6 MONTHS.

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Analysis 6.8

Comparison 6 CPA versus FLUTAMIDE, Outcome 8 TESTOSTERONE (FREE) AT 3 MONTHS.

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Analysis 6.9

Comparison 6 CPA versus FLUTAMIDE, Outcome 9 TESTOSTERONE (FREE) AT 6 MONTHS.

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Analysis 6.10

Comparison 6 CPA versus FLUTAMIDE, Outcome 10 TESTOSTERONE (FREE) AT 12 MONTHS.

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Analysis 6.11

Comparison 6 CPA versus FLUTAMIDE, Outcome 11 ANDROSTENEDIONE AT 3 MONTHS.

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Analysis 6.12

Comparison 6 CPA versus FLUTAMIDE, Outcome 12 ANDROSTENEDIONE AT 6 MONTHS.

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Analysis 6.13

Comparison 6 CPA versus FLUTAMIDE, Outcome 13 DHEAS AT 3 MONTHS.

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Analysis 6.14

Comparison 6 CPA versus FLUTAMIDE, Outcome 14 DHEAS AT 6 MONTHS.

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Analysis 6.15

Comparison 6 CPA versus FLUTAMIDE, Outcome 15 DHEAS AT 12 MONTHS.

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Analysis 6.16

Comparison 6 CPA versus FLUTAMIDE, Outcome 16 SHBG AT 3 MONTHS.

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Analysis 6.17

Comparison 6 CPA versus FLUTAMIDE, Outcome 17 SHBG AT 6 MONTHS.

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Analysis 7.1

Comparison 7 CPA versus FINASTERIDE, Outcome 1 FERRIMAN GALLWEY AT 3 MONTHS.

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Analysis 7.2

Comparison 7 CPA versus FINASTERIDE, Outcome 2 FERRIMAN GALLWEY AT 6 MONTHS.

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Analysis 7.3

Comparison 7 CPA versus FINASTERIDE, Outcome 3 FERRIMAN GALLWEY AT 12 MONTHS.

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Analysis 7.4

Comparison 7 CPA versus FINASTERIDE, Outcome 4 TESTOSTERONE (TOTAL) AT 3 MONTHS.

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Analysis 7.5

Comparison 7 CPA versus FINASTERIDE, Outcome 5 TESTOSTERONE (TOTAL) AT 6 MONTHS.

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Analysis 7.6

Comparison 7 CPA versus FINASTERIDE, Outcome 6 TESTOSTERONE (TOTAL) AT 12 MONTHS.

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Analysis 7.7

Comparison 7 CPA versus FINASTERIDE, Outcome 7 TESTOSTERONE (FREE) AT 3 MONTHS.

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Analysis 7.8

Comparison 7 CPA versus FINASTERIDE, Outcome 8 TESTOSTERONE (FREE) AT 6 MONTHS.

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Analysis 7.9

Comparison 7 CPA versus FINASTERIDE, Outcome 9 TESTOSTERONE (FREE) AT 12 MONTHS.

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Analysis 7.10

Comparison 7 CPA versus FINASTERIDE, Outcome 10 3 ALPHA ANDROSTENEDIOL GLUCORONIDE AT 6 MONTHS.

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Analysis 8.1

Comparison 8 CPA versus GNRH, Outcome 1 SIDE EFFECTS.

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Analysis 8.2

Comparison 8 CPA versus GNRH, Outcome 2 FERRIMAN GALLWEY AT 3 MONTHS.

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Analysis 8.3

Comparison 8 CPA versus GNRH, Outcome 3 TESTOSTERONE (TOTAL) AT 3 MONTHS.

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Analysis 8.4

Comparison 8 CPA versus GNRH, Outcome 4 ANDROSTENEDIONE AT 3 MONTHS.

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Comparison 2. CPA (2MG) + EE versus PLACEBO

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 SUBJECTIVE IMPROVEMENT IN HAIR GROWTH Show forest plot	1	20	Odds Ratio (M‐H, Fixed, 95% CI)	45.0 [2.01, 1006.75]

Comparison 2. CPA (2MG) + EE versus PLACEBO

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Comparison 3. CPA (>2MG) + EE versus CPA(2MG) + EE

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 FERRIMAN GALLWEY AT 6 MONTHS Show forest plot	1	113	Mean Difference (IV, Fixed, 95% CI)	1.10 [‐0.71, 2.91]

2 TESTOSTERONE (TOTAL) AT 6 MONTHS Show forest plot	1	113	Mean Difference (IV, Fixed, 95% CI)	‐0.49 [‐1.78, 0.80]

3 TESTOSTERONE LEVEL (FREE) AT 6 MONTHS Show forest plot	1	113	Mean Difference (IV, Fixed, 95% CI)	0.35 [‐0.61, 1.31]

4 ANDROSTENEDIONE LEVEL AT 6 MONTHS Show forest plot	1	113	Mean Difference (IV, Fixed, 95% CI)	‐0.35 [‐1.32, 0.62]

5 DHEAS LEVEL AT 6 MONTHS Show forest plot	1	113	Mean Difference (IV, Fixed, 95% CI)	0.18 [1.00, 1.36]

6 ESTRADIOL LEVEL AT 6 MONTHS Show forest plot	1	113	Mean Difference (IV, Fixed, 95% CI)	‐19.0 [‐103.67, 65.67]

Comparison 3. CPA (>2MG) + EE versus CPA(2MG) + EE

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Comparison 4. CPA versus KETOCONAZOLE

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 FERRIMAN GALLWEY AT 6 MONTHS Show forest plot	1	81	Mean Difference (IV, Fixed, 95% CI)	0.70 [‐0.84, 2.24]

2 TESTOSTERONE (TOTAL) AT 6 MONTHS Show forest plot	1	81	Mean Difference (IV, Fixed, 95% CI)	‐0.02 [‐0.37, 0.33]

3 TESTOSTERONE (FREE) AT 6 MONTHS Show forest plot	1	81	Mean Difference (IV, Fixed, 95% CI)	1.39 [0.43, 2.35]

4 ANDROSTENEDIONE AT 6 MONTHS Show forest plot	1	81	Mean Difference (IV, Fixed, 95% CI)	0.35 [‐0.62, 1.32]

5 DHEAS AT 6 MONTHS Show forest plot	1	81	Mean Difference (IV, Fixed, 95% CI)	2.87 [1.99, 3.75]

6 ESTRADIOL AT 6 MONTHS Show forest plot	1	81	Mean Difference (IV, Fixed, 95% CI)	135.0 [59.92, 210.08]

Comparison 4. CPA versus KETOCONAZOLE

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Comparison 5. CPA versus SPIRONOLACTONE

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 WITHDRAWALS DURING TREATMENT Show forest plot	1	48	Odds Ratio (M‐H, Fixed, 95% CI)	0.37 [0.03, 4.33]

2 FERRIMAN GALLWEY AT 3 MONTHS Show forest plot	2	83	Mean Difference (IV, Fixed, 95% CI)	‐1.98 [‐4.12, 0.16]

3 FERRIMAN GALLWEY AT 6 MONTHS Show forest plot	3	160	Mean Difference (IV, Fixed, 95% CI)	‐1.35 [‐2.87, 0.18]

4 SIDE EFFECTS DURING TREATMENT Show forest plot	2	90	Odds Ratio (M‐H, Fixed, 95% CI)	0.75 [0.21, 2.70]

5 LINEAR HAIR GROWTH AT 3 MONTHS Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	0.02 [‐0.03, 0.07]

6 LINEAR HAIR GROWTH AT 6 MONTHS Show forest plot	1	41	Mean Difference (IV, Fixed, 95% CI)	‐0.04 [‐0.09, 0.01]

7 HAIR SHAFT DIAMETER AT 6 MONTHS Show forest plot	1	45	Mean Difference (IV, Fixed, 95% CI)	3.00 [‐23.85, 29.85]

8 TESTOSTERONE (TOTAL) AT 6 MONTHS Show forest plot	3	164	Mean Difference (IV, Fixed, 95% CI)	‐0.00 [‐0.28, 0.27]

9 TESTOSTERONE (FREE) AT 6 MONTHS Show forest plot	1	77	Mean Difference (IV, Fixed, 95% CI)	0.35 [‐0.62, 1.32]

10 ANDROSTENEDIONE AT 6 MONTHS Show forest plot	2	122	Mean Difference (IV, Fixed, 95% CI)	‐0.20 [‐1.66, 1.25]

11 DHEAS AT 6 MONTHS Show forest plot	3	164	Mean Difference (IV, Fixed, 95% CI)	‐0.74 [‐1.71, 0.24]

12 SHBG AT 6 MONTHS Show forest plot	1	45	Mean Difference (IV, Fixed, 95% CI)	9.20 [‐27.20, 45.60]

13 ESTRADIOL AT 6 MONTHS Show forest plot	1	77	Mean Difference (IV, Fixed, 95% CI)	119.00 [10.84, 227.16]

Comparison 5. CPA versus SPIRONOLACTONE

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Comparison 6. CPA versus FLUTAMIDE

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 WITHDRAWALS FROM TREATMENT Show forest plot	1	26	Odds Ratio (M‐H, Fixed, 95% CI)	3.6 [0.32, 40.23]

2 FERRIMAN GALLWEY AT 3 MONTHS Show forest plot	3	72	Mean Difference (IV, Fixed, 95% CI)	0.37 [‐1.22, 1.95]

3 FERRIMAN GALLWEY AT 6 MONTHS Show forest plot	2	50	Mean Difference (IV, Fixed, 95% CI)	1.50 [‐1.06, 4.06]

4 FERRIMAN GALLWEY AT 12 MONTHS Show forest plot	1	28	Mean Difference (IV, Fixed, 95% CI)	4.5 [0.47, 8.53]

5 SIDE EFFECTS Show forest plot	3	73	Odds Ratio (M‐H, Fixed, 95% CI)	0.66 [0.17, 2.51]

6 TESTOSTERONE (TOTAL) AT 3 MONTHS Show forest plot	1	22	Mean Difference (IV, Fixed, 95% CI)	0.0 [‐0.45, 0.45]

7 TESTOSTERONE (TOTAL) AT 6 MONTHS Show forest plot	1	22	Mean Difference (IV, Fixed, 95% CI)	‐0.69 [‐1.14, ‐0.24]

8 TESTOSTERONE (FREE) AT 3 MONTHS Show forest plot	1	28	Mean Difference (IV, Fixed, 95% CI)	‐5.37 [‐10.29, ‐0.45]

9 TESTOSTERONE (FREE) AT 6 MONTHS Show forest plot	1	28	Mean Difference (IV, Fixed, 95% CI)	‐4.16 [‐6.62, ‐1.70]

10 TESTOSTERONE (FREE) AT 12 MONTHS Show forest plot	1	28	Mean Difference (IV, Fixed, 95% CI)	‐4.55 [‐7.43, ‐1.67]

11 ANDROSTENEDIONE AT 3 MONTHS Show forest plot	1	22	Mean Difference (IV, Fixed, 95% CI)	‐2.79 [‐6.51, 0.93]

12 ANDROSTENEDIONE AT 6 MONTHS Show forest plot	1	22	Mean Difference (IV, Fixed, 95% CI)	‐2.45 [‐5.90, 1.00]

13 DHEAS AT 3 MONTHS Show forest plot	2	50	Mean Difference (IV, Fixed, 95% CI)	0.41 [‐0.04, 0.85]

14 DHEAS AT 6 MONTHS Show forest plot	2	50	Mean Difference (IV, Fixed, 95% CI)	0.28 [‐0.31, 0.87]

15 DHEAS AT 12 MONTHS Show forest plot	1	28	Mean Difference (IV, Fixed, 95% CI)	1.16 [‐0.38, 2.70]

16 SHBG AT 3 MONTHS Show forest plot	1	22	Mean Difference (IV, Fixed, 95% CI)	1.19 [‐1.57, 3.95]

17 SHBG AT 6 MONTHS Show forest plot	1	22	Mean Difference (IV, Fixed, 95% CI)	1.17 [‐2.42, 4.76]

Comparison 6. CPA versus FLUTAMIDE

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Comparison 7. CPA versus FINASTERIDE

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 FERRIMAN GALLWEY AT 3 MONTHS Show forest plot	1	27	Mean Difference (IV, Fixed, 95% CI)	4.70 [‐1.86, 11.26]

2 FERRIMAN GALLWEY AT 6 MONTHS Show forest plot	1	27	Mean Difference (IV, Fixed, 95% CI)	‐0.20 [‐5.50, 5.10]

3 FERRIMAN GALLWEY AT 12 MONTHS Show forest plot	1	27	Mean Difference (IV, Fixed, 95% CI)	‐0.10 [‐5.09, 4.89]

4 TESTOSTERONE (TOTAL) AT 3 MONTHS Show forest plot	1	27	Mean Difference (IV, Fixed, 95% CI)	‐1.11 [‐1.81, ‐0.41]

5 TESTOSTERONE (TOTAL) AT 6 MONTHS Show forest plot	1	27	Mean Difference (IV, Fixed, 95% CI)	‐1.60 [‐2.39, ‐0.81]

6 TESTOSTERONE (TOTAL) AT 12 MONTHS Show forest plot	1	27	Mean Difference (IV, Fixed, 95% CI)	‐2.08 [‐3.13, ‐1.03]

7 TESTOSTERONE (FREE) AT 3 MONTHS Show forest plot	1	27	Mean Difference (IV, Fixed, 95% CI)	‐4.72 [‐7.69, ‐1.75]

8 TESTOSTERONE (FREE) AT 6 MONTHS Show forest plot	1	27	Mean Difference (IV, Fixed, 95% CI)	‐9.02 [‐12.44, ‐5.60]

9 TESTOSTERONE (FREE) AT 12 MONTHS Show forest plot	1	27	Mean Difference (IV, Fixed, 95% CI)	‐11.70 [‐15.67, ‐7.73]

10 3 ALPHA ANDROSTENEDIOL GLUCORONIDE AT 6 MONTHS Show forest plot	1	27	Mean Difference (IV, Fixed, 95% CI)	‐0.71 [‐5.05, 3.63]

Comparison 7. CPA versus FINASTERIDE

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Comparison 8. CPA versus GNRH

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 SIDE EFFECTS Show forest plot	1	21	Odds Ratio (M‐H, Fixed, 95% CI)	1.93 [0.25, 14.89]

2 FERRIMAN GALLWEY AT 3 MONTHS Show forest plot	1	21	Mean Difference (IV, Fixed, 95% CI)	‐2.80 [‐5.85, 0.25]

3 TESTOSTERONE (TOTAL) AT 3 MONTHS Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	0.17 [‐0.15, 0.49]

4 ANDROSTENEDIONE AT 3 MONTHS Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	0.66 [‐0.44, 1.76]

Comparison 8. CPA versus GNRH

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