Therapeutics
Review: In peri- or postmenopausal women, DHEA does not improve symptoms and increases androgenic side effects Clinical impact rating:
Scheffers CS, Armstrong S, Cantineau AE, Farquhar C, Jordan V. Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database Syst Rev. 2015;1:CD011066.
多多多多多夞夞
Question In women with peri- or postmenopausal symptoms, is dehydroepiandrosterone (DHEA) effective and safe for improving symptoms?
Review scope Included studies compared DHEA, administered for ≥ 1 week, with placebo, no intervention, or hormone therapy (HT) in menopausal women. Outcomes included quality of life (QoL), adverse effects, change in menopausal symptoms, and sexual function.
Review methods MEDLINE, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, Menstrual Disorders and Subfertility Group Specialised Register of controlled trials, PsycINFO, CINAHL, and LILACS (Jun 2014); Database of Abstracts of Reviews of Effects, Web of Knowledge, OpenGrey, Google, and trial Web sites (www.clinicaltrials.gov and www.who.int/trialsearch /Default.aspx); and reference lists and conference abstracts were searched for randomized controlled trials (RCTs). 28 RCTs (n = 1273; 1207 postmenopausal women, 66 perimenopausal women, age range 36 to 80 y) met the selection criteria. DHEA was administered orally (23 trials), by skin (3 RCTs), or intravaginally (2 RCTs). Control groups received placebo (23 RCTs), HT (6 RCTs), tibolone (3 RCTs), or no treatment (1 RCT). 17 RCTs reported random-sequence generation, 9 reported allocation concealment, and 14 used blinding.
Main results Meta-analysis showed that DHEA did not improve QoL, change in menopausal symptoms, or sexual function compared with placebo or no treatment (Table); DHEA increased androgenic side effects (acne, greasy skin, and hirsutism) (1 RCT, odds ratio 6.57, 95% CI 1.37 to 31.59) but not acne or hirsutism individually. DHEA did not improve sexual function (2 RCTs, standard mean difference 1.26, CI ⫺0.21 to 2.73) compared with HT; data were insufficient for QoL, menopausal symptoms, and adverse effects.
Conclusion In symptomatic women with peri- or postmenopausal symptoms, dehydroepiandrosterone did not improve menopausal symptoms and resulted in increased androgenic side effects compared with placebo or no treatment. Sources of funding: Groninger Universiteitsfonds and Rijksuniversiteit Groningen, The Netherlands.
For correspondence: Dr. C.S. Scheffers, University of Groningen, Groningen, The Netherlands. E-mail [email protected].
Commentary Vasomotor and sexual symptoms plague women during the menopausal transition, but the results of the WHI trial (1) scared many women and practitioners away from HT. In attempting to relieve symptoms, many women have turned to other supplements, including DHEA, that have been advocated with little or no scientific support regarding effects or comprehensive assessments of risks. That DHEA is a steroid precursor for testosterone and estradiol provides biologic plausibility that use may confer benefit. The effects of exogenous use of DHEA with normal adrenal function are not well-understood (2). The well-executed meta-analysis by Scheffers and colleagues highlights the difficulties of combining data from small studies with heterogeneous interventions, outcomes, and measurement tools. The quality of evidence was rated as low to moderate, with acknowledgment that the effects and estimates of even moderate-level evidence may change with further research. RCTs that assessed androgenic side effects, including acne and hirsutism, found increases with DHEA compared with placebo or no treatment, but trials that assessed acne and hirsutism separately, using similar controls, did not find increases with DHEA use. RCTs that compared DHEA with HT were small and failed to show any advantage of DHEA for sexual function or control of vasomotor symptoms. The meta-analysis by Scheffers and colleagues suggests that DHEA does not perform better than HT, only mildly better than placebo, and no better than no treatment for QoL, vasomotor symptoms, and sexual function. The increase in androgenic side effects suggests that DHEA may do more harm than good. Donna M. Fedorkow, MD, FRCSC, MSc McMaster University Hamilton, Ontario, Canada References 1. Rossouw JE, Anderson GL, Prentice RL, et al; Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002;288:32133. 2. Elraiyah T, Sonbol MB, Wang Z, et al. Clinical review: The benefits and harms of systemic dehydroepiandrosterone (DHEA) in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2014;99:3536-42.
DHEA vs placebo or no treatment in peri- or postmenopausal women* Outcomes
Number of trials (n)
Standard mean difference (95% CI)
Quality of life or well-being
9 (402)
⫺0.04 (⫺0.20 to 0.13)†
Change in menopausal symptoms
1 (66)
0.07 (⫺0.42 to 0.55)†
Sexual function
6 (376)
0.19 (⫺0.01 to 0.40)‡
*DHEA = dehydroepiandrosterone; CI defined in Glossary. †Difference favors control. ‡Difference favors DHEA.
19 May 2015 Annals of Internal Medicine ACP Journal Club Downloaded From: http://annals.org/ by a University of Birmingham User on 05/28/2015
JC9
姝 2015 American College of Physicians
Review: In peri- or postmenopausal women, DHEA does not improve symptoms and increases androgenic side effects Clinical impact rating:
Scheffers CS, Armstrong S, Cantineau AE, Farquhar C, Jordan V. Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database Syst Rev. 2015;1:CD011066.
多多多多多夞夞
Question In women with peri- or postmenopausal symptoms, is dehydroepiandrosterone (DHEA) effective and safe for improving symptoms?
Review scope Included studies compared DHEA, administered for ≥ 1 week, with placebo, no intervention, or hormone therapy (HT) in menopausal women. Outcomes included quality of life (QoL), adverse effects, change in menopausal symptoms, and sexual function.
Review methods MEDLINE, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, Menstrual Disorders and Subfertility Group Specialised Register of controlled trials, PsycINFO, CINAHL, and LILACS (Jun 2014); Database of Abstracts of Reviews of Effects, Web of Knowledge, OpenGrey, Google, and trial Web sites (www.clinicaltrials.gov and www.who.int/trialsearch /Default.aspx); and reference lists and conference abstracts were searched for randomized controlled trials (RCTs). 28 RCTs (n = 1273; 1207 postmenopausal women, 66 perimenopausal women, age range 36 to 80 y) met the selection criteria. DHEA was administered orally (23 trials), by skin (3 RCTs), or intravaginally (2 RCTs). Control groups received placebo (23 RCTs), HT (6 RCTs), tibolone (3 RCTs), or no treatment (1 RCT). 17 RCTs reported random-sequence generation, 9 reported allocation concealment, and 14 used blinding.
Main results Meta-analysis showed that DHEA did not improve QoL, change in menopausal symptoms, or sexual function compared with placebo or no treatment (Table); DHEA increased androgenic side effects (acne, greasy skin, and hirsutism) (1 RCT, odds ratio 6.57, 95% CI 1.37 to 31.59) but not acne or hirsutism individually. DHEA did not improve sexual function (2 RCTs, standard mean difference 1.26, CI ⫺0.21 to 2.73) compared with HT; data were insufficient for QoL, menopausal symptoms, and adverse effects.
Conclusion In symptomatic women with peri- or postmenopausal symptoms, dehydroepiandrosterone did not improve menopausal symptoms and resulted in increased androgenic side effects compared with placebo or no treatment. Sources of funding: Groninger Universiteitsfonds and Rijksuniversiteit Groningen, The Netherlands.
For correspondence: Dr. C.S. Scheffers, University of Groningen, Groningen, The Netherlands. E-mail [email protected].
Commentary Vasomotor and sexual symptoms plague women during the menopausal transition, but the results of the WHI trial (1) scared many women and practitioners away from HT. In attempting to relieve symptoms, many women have turned to other supplements, including DHEA, that have been advocated with little or no scientific support regarding effects or comprehensive assessments of risks. That DHEA is a steroid precursor for testosterone and estradiol provides biologic plausibility that use may confer benefit. The effects of exogenous use of DHEA with normal adrenal function are not well-understood (2). The well-executed meta-analysis by Scheffers and colleagues highlights the difficulties of combining data from small studies with heterogeneous interventions, outcomes, and measurement tools. The quality of evidence was rated as low to moderate, with acknowledgment that the effects and estimates of even moderate-level evidence may change with further research. RCTs that assessed androgenic side effects, including acne and hirsutism, found increases with DHEA compared with placebo or no treatment, but trials that assessed acne and hirsutism separately, using similar controls, did not find increases with DHEA use. RCTs that compared DHEA with HT were small and failed to show any advantage of DHEA for sexual function or control of vasomotor symptoms. The meta-analysis by Scheffers and colleagues suggests that DHEA does not perform better than HT, only mildly better than placebo, and no better than no treatment for QoL, vasomotor symptoms, and sexual function. The increase in androgenic side effects suggests that DHEA may do more harm than good. Donna M. Fedorkow, MD, FRCSC, MSc McMaster University Hamilton, Ontario, Canada References 1. Rossouw JE, Anderson GL, Prentice RL, et al; Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002;288:32133. 2. Elraiyah T, Sonbol MB, Wang Z, et al. Clinical review: The benefits and harms of systemic dehydroepiandrosterone (DHEA) in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2014;99:3536-42.
DHEA vs placebo or no treatment in peri- or postmenopausal women* Outcomes
Number of trials (n)
Standard mean difference (95% CI)
Quality of life or well-being
9 (402)
⫺0.04 (⫺0.20 to 0.13)†
Change in menopausal symptoms
1 (66)
0.07 (⫺0.42 to 0.55)†
Sexual function
6 (376)
0.19 (⫺0.01 to 0.40)‡
*DHEA = dehydroepiandrosterone; CI defined in Glossary. †Difference favors control. ‡Difference favors DHEA.
19 May 2015 Annals of Internal Medicine ACP Journal Club Downloaded From: http://annals.org/ by a University of Birmingham User on 05/28/2015
JC9
姝 2015 American College of Physicians
