Oral Spironolactone for Acne Vulgaris in Adult Females: A Hybrid Systematic Review
| Autor: | E. Anne Eady, Esther J van Zuuren, Alison M. Layton, Heather Whitehouse, James Q Del Rosso, Zbys Fedorowicz |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
medicine.medical_specialty MEDLINE Administration Oral Dermatology Spironolactone Placebo law.invention Sebaceous Glands 030207 dermatology & venereal diseases 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Randomized controlled trial law Internal medicine Acne Vulgaris medicine Humans Treatment Failure 030212 general & internal medicine Acne Mineralocorticoid Receptor Antagonists Randomized Controlled Trials as Topic Gynecology business.industry Hyperandrogenism General Medicine medicine.disease Crossover study Anti-Bacterial Agents Contraceptives Oral Combined chemistry Concomitant Androgens Female Systematic Review business |
| Zdroj: | American Journal of Clinical Dermatology, 18(2), 169-191 American Journal of Clinical Dermatology |
| Popis: | Background The management of acne in adult females is problematic, with many having a history of treatment failure and some having a predisposition to androgen excess. Alternatives to oral antibiotics and combined oral contraceptives (COCs) are required. Objective Our aim was to conduct a hybrid systematic review of the evidence for benefits and potential harms of oral spironolactone in the management of acne in adult females. Methods The review was conducted according to a previously published protocol. Three reviewers independently selected relevant studies from the search results, extracted data, assessed the risk of bias, and rated the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Ten randomized controlled trials (RCTs) and 21 case series were retrieved. All trials were assessed as being at a ‘high risk’ of bias, and the quality of evidence was rated as low or very low for all outcomes. Apart from one crossover trial that demonstrated statistical superiority of a 200 mg daily dose versus inflamed lesions compared with placebo, data from the remaining trials were unhelpful in establishing the degree of efficacy of lower doses versus active comparators or placebo. Menstrual side effects were significantly more common with the 200 mg dose; frequency could be significantly reduced by concomitant use of a COC. Pooling of results for serum potassium supported the recent recommendation that routine monitoring is not required in this patient population. Conclusion This systematic review of RCTs and case series identified evidence of limited quality to underpin the expert endorsement of spironolactone at the doses typically used (≤100 mg/day) in everyday clinical practice. Electronic supplementary material The online version of this article (doi:10.1007/s40257-016-0245-x) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|