Route-specific association of progestin therapy and concurrent metformin use in obese women with complex atypical hyperplasia
Autor: | Elise B. Morocco, Begüm Özel, Koji Matsuo, Christina E. Dancz, Marcia A. Ciccone, Mahdi Khoshchehreh, Lynda D. Roman, Heena Pursuwani, Rachel S. Mandelbaum, Richard J. Paulson, Shinya Matsuzaki |
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Rok vydání: | 2020 |
Předmět: |
Adult
medicine.medical_specialty medicine.drug_class Population Intrauterine device Gastroenterology Atypical hyperplasia Internal medicine medicine Humans Obesity education Retrospective Studies education.field_of_study Hyperplasia business.industry Hazard ratio Obstetrics and Gynecology Middle Aged medicine.disease Metformin Endometrial Neoplasms Endometrial hyperplasia Oncology Female Progestins business Progestin Body mass index medicine.drug |
Zdroj: | International Journal of Gynecologic Cancer. 30:1-9 |
ISSN: | 1525-1438 1048-891X |
Popis: | IntroductionPrevious studies have suggested that metformin use may enhance the therapeutic effect of progestin therapy for endometrial hyperplasia or malignancy. However, it is not known how the impact of concurrent metformin may be altered by route of progestin therapy, either locally via an intrauterine device or systemically. This study examined the effectiveness of concurrent metformin use and progestin therapy for women with complex atypical hyperplasia stratified by progestin route (systemic vs local).MethodsThis single-institution retrospective study examined consecutive women with complex atypical hyperplasia who received progestin therapy from 2003 to 2018. Time-dependent analyses for complete response rate were performed comparing concurrent metformin users versus non-users in the oral progestin group and in the levonorgestrel-releasing intrauterine device group.ResultsAcross the study cohort (n=245), there were 137 (55.9%) women who responded to progestin therapy. In the oral progestin group (n=176), the median age and body mass index were 36 years and 37.7 kg/m2, respectively. 36 (20.5%) of women on oral progestins also took metformin. After controlling for diabetes status, women taking both oral progestins and metformin had a complete response rate similar to those not taking metformin (6 month cumulative rates, 23.1% vs 27.8%, adjusted hazard ratio (aHR) 0.71, 95% confidence interval (95% CI) 0.36 to 1.41). In the levonorgestrel-releasing intrauterine device group (n=69), the median age and body mass index were 35 years and 39.9 kg/m2, respectively. There were 15 (21.7%) women who took metformin in addition to the levonorgestrel-releasing intrauterine device. After controlling for diabetes status, women who had the levonorgestrel-releasing intrauterine device and took metformin had a significantly higher complete response rate compared with those not taking metformin (6 month cumulative rates, 86.7% vs 58.9%, aHR 2.31, 95% CI 1.09 to 4.89).ConclusionIn a predominantly obese population, concurrent metformin may possibly offer treatment benefit when used with the levonorgestrel-releasing intrauterine device. |
Databáze: | OpenAIRE |
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