title: Clinical review: Antiandrogens for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials.
abstract: BACKGROUND
  The relative efficacy of antiandrogens for the treatment of hirsutism remains unclear.
  
  
  OBJECTIVE
  We performed a systematic review and metaanalyses of randomized controlled trials (RCTs) evaluating the effect of antiandrogens on hirsutism.
  
  
  METHODS
  We used librarian-designed search strategies for MEDLINE, EMBASE, and Cochrane CENTRAL (up to May 2006), review of reference lists, and contact with hirsutism experts to identify eligible RCTs.
  
  
  METHODS
  Eligible studies were RCTs of at least 6 months of antiandrogen use in women with hirsutism. Reviewers, with acceptable chance-adjusted agreement (kappa = 0.72), independently assessed eligibility.
  
  
  METHODS
  Reviewers used structured forms to assess and collect methodological quality (allocation concealment, blinding, and loss to follow-up) and study data.
  
  
  RESULTS
  Of 348 candidate studies, 12 were eligible (18 comparisons). Their methodological quality was low. Random-effects metaanalyses showed that compared with placebo, antiandrogens reduce Ferriman-Gallwey scores by 3.9 [95% confidence interval (CI), 2.3-5.4; inconsistency (I(2)) = 0%]. When compared with metformin, spironolactone reduced hirsutism scores by 1.3 (CI, 0.03-2.6) and flutamide by 5.0 (CI, 3.0-7.0; I(2) = 0%). For these interventions, two to five women need to receive treatment for one to notice improvement. Spironolactone or finasteride in combination with contraceptives (1.7; CI, 0.1-3.3; I(2) = 0%) or flutamide with metformin (4.6; CI, 1.3-7.9; I(2) = 40%) appear superior to monotherapy with contraceptives and metformin, respectively. Only three RCTs reported patient self-assessments of hirsutism.
  
  
  CONCLUSIONS
  Weak evidence suggests antiandrogens are mildly effective agents for the treatment of hirsutism.
authors.affiliation: Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Swiglo
authors.forename: Mihaela
authors.initials: M
authors.lastname: Cosma
authors.forename: David N
authors.initials: DN
authors.lastname: Flynn
authors.forename: David M
authors.initials: DM
authors.lastname: Kurtz
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Labella
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Mullan
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use*; D006628:Hirsutism / Q000188:drug therapy*; D006801:Humans; D008687:Metformin / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
chemical_list: D000726:Androgen Antagonists; D008687:Metformin