Кломифен лучше метформина при бесплодии и синдроме поликистозн. яичников

[Dr.Vad]

[Ссылки доступны только зарегистрированным пользователям ]

Legro RS, Barnhart HX, Schlaff WD, Carr BR, Diamond MP, Carson SA, Steinkampf MP, Coutifaris C, McGovern PG, Cataldo NA, Gosman GG, Nestler JE, Giudice LC, Leppert PC, Myers ER; Cooperative Multicenter Reproductive Medicine Network.
Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome.
N Engl J Med. 2007 Feb 8;356(6):551-66.

[Ссылки доступны только зарегистрированным пользователям ]

Ред. комментарий:

Guzick DS.
Treating the polycystic ovary syndrome the old-fashioned way.
N Engl J Med. 2007 Feb 8;356(6):622-4.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr. Nika]

И теперь тот же медскейп публикует следующее
Metformin Better Inducer of Ovulation in Infertile PCOS Women




NEW YORK (Reuters Health) Feb 08 - Metformin on its own or in combination with clomiphene citrate appears to be better than clomiphene alone in inducing ovulation in women with polycystic ovary syndrome (PCOS), Canadian researchers report in the January issue of Fertility and Sterility.

Senior investigator Dr. Helene B. Lavoie told Reuters Health that "once we prove that metformin is at least as effective as clomiphene citrate for ovulation induction and pregnancy for PCOS women, it should replace clomiphene as first-line therapy, since it does not increase ovarian cysts and multiple gestations, and it has beneficial effects on metabolism and possibly miscarriage rates."

In the current observational study, Dr. Lavoie of PROCREA Cliniques, Mont-Royal and colleagues enrolled 154 infertile women with oligomenorrhea and hyperandrogenism. They were randomized to receive 500 mg of metformin three times per day; clomiphene at 50 mg on days 5 to 9 of the ovulatory cycle, or a combination of both medications.

Patients on metformin alone had higher ovulation rates (75.4%) than those given clomiphene alone (50.0%) and the combination treatment (63.4%).

Pregnancy rates were similar in all three treatment groups.

The response to metformin was independent of body weight and dose. Therefore, women unable to tolerate the drug 500-mg three times daily can reduce the dosage and it still may be effective.

Given these findings and the safety and low cost of metformin, the researchers suggest that it be offered "as first-line therapy in all anovulatory women with PCOS desiring pregnancy."

Fertil Steril 2007;87:113-120.

[Dr.Vad]

Уважаемая коллега,

Спасибо за ссылку, хочется отметить разность первичных точек в этих исследованиях: в канадском -частота овуляции, в штатовском (NEJM) - частота рожденных живых детей (согласитесь, что вторая точка несколько "потверже"). Вот фрагменты ред. комментария на эту тему:

How can one reconcile the finding that the live-birth rate in the clomiphene group was three times that in the metformin group with the meta-analysis of several earlier trials suggesting the superiority of metformin?8 Inconsistencies have previously been recognized between results of meta-analyses of small trials and subsequent large, randomized, controlled trials12; such discrepancies are more likely to occur when studies in a meta-analysis have methodologic flaws or when there is heterogeneity in populations, treatments, and outcomes. In the meta-analysis of trials of infertility treatments in women with the polycystic ovary syndrome,8 most of the trials that showed improved rates of ovulation or pregnancy with combination therapy included only women with clomiphene resistance. Moreover, intention-to-treat analyses were seldom used, and rates of ovulation or pregnancy were generally used as end points. Focusing on live-birth rates, the end point used by Legro et al., is preferable in view of potential discrepancies between rates of ovulation and pregnancy and between rates of pregnancy and live births.

(N Engl J Med. 2007 Feb 8;356(6):622-4)

[Dr. Nika]

Уважаемый Вадим Валерьевич,

Конечно, я с Вами согласна. Я поместила эту ссылку не в плане спора, а просто как продолжение темы исследований на эту тему.

Сообщение от Dr. Vad

Focusing on live-birth rates, the end point used by Legro et al., is preferable in view of potential discrepancies between rates of ovulation and pregnancy and between rates of pregnancy and live births.

(N Engl J Med. 2007 Feb 8;356(6):622-4)

Бесспорный вывод!