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Rhodes JR, Alldredge CT, Elkins GR. Magnitude of placebo response in clinical trials of paroxetine for vasomotor symptoms: a meta-analysis. Front Psychiatry 2023; 14:1204163. [PMID: 37599891 PMCID: PMC10436555 DOI: 10.3389/fpsyt.2023.1204163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Vasomotor symptoms, or hot flashes, are among the most common complaints for menopausal and postmenopausal women. As an alternative to hormone replacement therapy, paroxetine mesylate became the only non-hormonal treatment approved by the U.S. Food and Drug Administration (FDA), despite limited evidence for its efficacy. More specifically, there is uncertainty around paroxetine's unique benefit and the magnitude of the placebo response in clinical trials of paroxetine. Methods Relevant databases were searched to identify randomized clinical trials examining the efficacy of paroxetine to treat hot flashes. The primary outcomes of interest were hot flash frequency and hot flash severity scores. Data was extracted from the published results, and risk of bias assessments were conducted. Results Six randomized clinical trials that included a total of 1,486 women were coded and analyzed. The results demonstrated that 79% of the mean treatment response for hot flash frequency is accounted for by a placebo response, resulting in a mean true drug effect of 21% at most. Additionally, 68% of the mean treatment response for hot flash severity is accounted for by a placebo response, resulting in a maximum true drug effect of 32%. Discussion The results herein call into question the actual efficacy of the only FDA approved, non-hormonal treatment for hot flashes by demonstrating that a placebo response accounts for the majority of treatment responses for reductions in both hot flash frequency and severity. The findings provide evidence to reevaluate the use of paroxetine to treat postmenopausal hot flashes and emphasize the importance of considering effective, alternative treatments for vasomotor symptoms.
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Affiliation(s)
- Joshua R. Rhodes
- Department of Psychology, Abilene Christian University, Abilene, TX, United States
| | - Cameron T. Alldredge
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
| | - Gary R. Elkins
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
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Huang AJ, Cummings SR, Ganz P, Schembri M, Raghunathan H, Vittinghoff E, Gibson CJ, Grady D. Efficacy of Continuous Transdermal Nitroglycerin for Treating Hot Flashes by Inducing Nitrate Cross-tolerance in Perimenopausal and Postmenopausal Women: A Randomized Clinical Trial. JAMA Intern Med 2023; 183:776-783. [PMID: 37273224 PMCID: PMC10242506 DOI: 10.1001/jamainternmed.2023.1977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/06/2023] [Indexed: 06/06/2023]
Abstract
Importance Due to the potential risks of long-term systemic estrogen therapy, many menopausal women are interested in nonhormonal treatments for vasomotor symptoms. Physiologic studies indicate that nitric oxide plays a key role in mediating hot flash-related vasodilation, suggesting that nonhormonal medications that induce nitrate tolerance in the vasculature may offer therapeutic benefit for vasomotor symptoms. Objective To determine whether uninterrupted administration of transdermal nitroglycerin (NTG) to induce nitrate cross-tolerance decreased the frequency or severity of menopause-related hot flashes. Design, Setting, and Participants This randomized, double-blinded, placebo-controlled clinical trial included perimenopausal or postmenopausal women reporting 7 or more hot flashes per day who were recruited from northern California by study personnel at a single academic center. Patients were randomized between July 2017 and December 2021, and the trial ended in April 2022 when the last randomized participant completed follow-up. Interventions Uninterrupted daily use of transdermal NTG (participant-directed dose titration from 0.2-0.6 mg/h) or identical placebo patches. Main Outcome Measures Validated symptom diaries assessing changes in any hot flash frequency (primary outcome) and moderate-to-severe hot flash frequency over 5 and 12 weeks. Results Among the 141 randomized participants (70 NTG [49.6%], 71 placebo [50.4%]; 12 [85.8%] Asian, 16 [11.3%] Black or African American, 15 [10.6%] Hispanic or Latina, 3 [2.1%] multiracial, 1 [0.7%] Native Hawaiian or Pacific Islander, and 100 [70.9%] White or Caucasian individuals), a mean (SD) of 10.8 (3.5) hot flashes and 8.4 (3.6) moderate-to-severe hot flashes daily was reported at baseline. Sixty-five participants assigned to NTG (92.9%) and 69 assigned to placebo (97.2%) completed 12-week follow-up (P = .27). Over 5 weeks, the estimated change in any hot flash frequency associated with NTG vs placebo was -0.9 (95% CI, -2.1 to 0.3) episodes per day (P = .10), and change in moderate-to-severe hot flash frequency with NTG vs placebo was -1.1 (95% CI, -2.2 to 0) episodes per day (P = .05). At 12 weeks, treatment with NTG did not significantly decrease the frequency of any hot flashes (-0.1 episodes per day; 95% CI, -1.2 to 0.4) or moderate-to-severe hot flashes (-0.5 episodes per day; 95% CI, -1.6 to 0.7) relative to placebo. In analyses combining 5-week and 12-week data, no significant differences in change in the frequency of any hot flashes (-0.5 episodes per day; 95% CI, -1.6 to 0.6; P = .25) or moderate-to-severe hot flashes (-0.8 episodes per day; 95% CI, -1.9 to 0.2; P = .12) were detected with NTG vs placebo. At 1 week, 47 NTG (67.1%) and 4 placebo participants (5.6%) reported headache (P < .001), but only 1 participant in each group reported headache at 12 weeks. Conclusions and Relevance This randomized clinical trial found that continuous use of NTG did not result in sustained improvements in hot flash frequency or severity relative to placebo and was associated with more early but not persistent headache. Trial Registration Clinicaltrials.gov Identifier: NCT02714205.
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Affiliation(s)
- Alison J. Huang
- Department of Medicine, University of California, San Francisco
| | - Steven R. Cummings
- Department of Medicine, University of California, San Francisco
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco
| | - Peter Ganz
- Department of Medicine, University of California, San Francisco
| | - Michael Schembri
- Department of Obstetrics and Gynecology, University of California, San Francisco
| | | | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Carolyn J. Gibson
- San Francisco VA Health Care System, San Francisco, California
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Deborah Grady
- Department of Medicine, University of California, San Francisco
- Deputy Editor, JAMA Internal Medicine
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Estimation of placebo effect in randomized placebo-controlled trials for moderate or severe vasomotor symptoms: a meta-analysis. Menopause 2023; 30:5-10. [PMID: 36576440 DOI: 10.1097/gme.0000000000002094] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The Food and Drug Administration guidance recommended that for the indication of vasomotor symptoms (VMS), studies should enroll participants with minimum of seven to eight moderate to severe VMS per day at baseline, and coprimary endpoints should be the mean change in frequency/severity at weeks 4 and 12. This study aimed to estimate placebo effects in randomized controlled trials (RCTs) fulfilling this guidance. METHODS PubMed was searched using the following terms: "vasomotor symptom or hot flash or hot flashes or hot flash or hot flashes [title/abstract]," "menopause or climacteric," "RCT or randomized controlled or randomized controlled," "placebo [title/abstract]," and "frequency or severity." Inclusion criteria were as follows: (1) placebo controlled RCTs, (2) enrolling women with moderate or severe VMS with a minimal frequency more than seven to eight times per day or 50 times per week, and (3) efficacy measurements including mean change in VMS frequency from baseline at week 12. A random-effects model was used in the meta-analysis. RESULTS Seventeen studies were included for the estimation of VMS frequency reduction and 13 studies for severity. Estimated change of VMS frequency in placebo arms was -5.44 times per day (95% CI, -5.81 to -5.07 times per day) at week 12. For VMS severity, the estimated change at week 12 was -0.36 (95% CI, -0.46 to -0.27). CONCLUSION Substantial and consistent placebo effects were observed in RCTs for VMS treatment. These data suggest a reduction of 5.44 times per day in frequency and 0.36 in severity might be observed as a placebo effect.
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Wen X, Luo J, Mai Y, Li Y, Cao Y, Li Z, Han S, Fu Q, Zheng Q, Ding C, Zhu Z, Li L. Placebo Response to Oral Administration in Osteoarthritis Clinical Trials and Its Associated Factors: A Model-Based Meta-analysis. JAMA Netw Open 2022; 5:e2235060. [PMID: 36215072 PMCID: PMC9552894 DOI: 10.1001/jamanetworkopen.2022.35060] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE In osteoarthritis (OA) clinical trials, a placebo is often used as control. Therefore, a thorough understanding of the placebo response is important for guiding drug development in OA. OBJECTIVE To develop an oral placebo response model for OA. DATA SOURCES PubMed, EMBASE, and Cochrane Library databases were searched systematically from January 1, 1991, to July 2, 2022. STUDY SELECTION Randomized double-blind placebo-controlled trials of patients with primary OA were included. The interventions and placebo were administered orally. A total of 3032 trials were identified; of these, 130 (4.3%) met the inclusion criteria. DATA EXTRACTION AND SYNTHESIS Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, dosage form of the placebo, sample size, proportion of patients who previously used nonsteroidal anti-inflammatory drugs, publication year, intervention categories, Kellgren-Lawrence grades, proportion of White patients, duration of pain, funding source, and risk of bias were extracted. A model-based meta-analysis was used to evaluate the time course of the placebo response in OA treatment and estimate the influencing factors. For subgroup analyses, a meta-analysis with a random-effects model was used to summarize the typical values of the model parameters and their SEs. MAIN OUTCOMES AND MEASURES The primary end point was the time course of the oral placebo response on the WOMAC pain, stiffness, and function subscale scores. RESULTS The 130 trials selected for analysis included 12 673 participants (mean age, 59.9 years; 68.9% women). The baseline scores of WOMAC pain, stiffness, and function subscales were found to be significantly associated with the placebo response. The placebo response reached 90% of its maximum response between 5 and 7 weeks. The placebo responses on the WOMAC subscales were also associated with the sample size, proportion of patients who had previously used nonsteroidal anti-inflammatory drugs, intervention drugs, and publication year. CONCLUSIONS AND RELEVANCE In this study, an oral placebo response model of OA was developed that may quantitatively describe the placebo response at different baseline levels of symptoms. The findings may provide valuable references for future clinical trial design and decision-making.
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Affiliation(s)
- Xin Wen
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jieren Luo
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yiying Mai
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yang Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ying Cao
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zewei Li
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shun Han
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Quanyi Fu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Qingshan Zheng
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Changhai Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhaohua Zhu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lujin Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Messina M, Duncan A, Messina V, Lynch H, Kiel J, Erdman JW. The health effects of soy: A reference guide for health professionals. Front Nutr 2022; 9:970364. [PMID: 36034914 PMCID: PMC9410752 DOI: 10.3389/fnut.2022.970364] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/25/2022] [Indexed: 11/22/2022] Open
Abstract
Soy is a hotly debated and widely discussed topic in the field of nutrition. However, health practitioners may be ill-equipped to counsel clients and patients about the use of soyfoods because of the enormous, and often contradictory, amount of research that has been published over the past 30 years. As interest in plant-based diets increases, there will be increased pressure for practitioners to gain a working knowledge of this area. The purpose of this review is to provide concise literature summaries (400-500 words) along with a short perspective on the current state of knowledge of a wide range of topics related to soy, from the cholesterol-lowering effects of soy protein to the impact of isoflavones on breast cancer risk. In addition to the literature summaries, general background information on soyfoods, soy protein, and isoflavones is provided. This analysis can serve as a tool for health professionals to be used when discussing soyfoods with their clients and patients.
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Affiliation(s)
- Mark Messina
- Soy Nutrition Institute Global, Washington, DC, United States
| | - Alison Duncan
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | | | - Heidi Lynch
- Kinesiology Department, Point Loma Nazarene University, San Diego, CA, United States
| | - Jessica Kiel
- Scientific and Clinical Affairs, Medifast Inc., Baltimore, MD, United States
| | - John W. Erdman
- Division of Nutritional Sciences and Beckman Institute, Department of Food Science and Human Nutrition, University of Illinois at Urbana/Champaign, Urbana, IL, United States
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Yu S, He X, Shi H, Chen Y, Liu Z. Effectiveness of electro-press needle for menopause-associated hot flashes: Protocol of a randomized controlled trial. Medicine (Baltimore) 2022; 101:e28597. [PMID: 35147087 PMCID: PMC8830863 DOI: 10.1097/md.0000000000028597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hot flashes (HF) are a prevalent symptom associated with menopause affecting up to 85% of women aged 40 to 65 years. Previous studies indicated that acupuncture might relieve the symptom of HF significantly; however, its effectiveness has not been clarified quantitatively. Electro-press needles (EPN) is a novel acupuncture that combines a shallow tiny needle with an electrical transdermal stimulator. Either the needle or the electrical stimulator could function in the treatment. This study aims to evaluate the effectiveness of EPN in comparison with no intervention in relieving HF of perimenopausal and postmenopausal women. METHODS/DESIGN This study will be a 2-arm randomized waitlist controlled trial. According to the ratio of 1:1 and block randomization, a total of 122 patients with moderate or severe HF will be randomly allocated to either EPN group or waitlist control group. The EPN group will receive 3 sessions of EPN treatment each week in consecutive 6 weeks, 18 sessions in total. The waitlist control group will get no intervention over the first 6 weeks. All the patients will be followed up in the next 24 weeks. The primary outcome will be the percentage of the participants whose 24-hour mean HF is 50% less than the baseline at Week 6. Secondary outcomes will include HF score, HF frequency, HF severity, the Menopause Rating Scale and Menopause-Specific Quality of Life Questionnaire Score. DISCUSSION This study will evaluate the effectiveness and safety of EPN treatment to alleviate HF symptoms in perimenopausal and postmenopausal women, excluding self-healing factors. The limitations of the trial design are its single-center scope, lack of placebo control and impossible to blind the acupuncturists and patients.Trial registration: This clinical trial has been registered in Clinical Trial Registry (registration number: NCT04995107; date of registration: Aug 6, 2021).
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Affiliation(s)
- Shudan Yu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xin He
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Hangyu Shi
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Yu Chen
- New Zealand College of Chinese Medicine, Greenlane, Aukland, New Zealand
| | - Zhishun Liu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Miyazaki K, Kaneko M, Narukawa M. Factors associated with high placebo response in clinical studies of hot flashes: a meta-analysis. Menopause 2021; 29:239-246. [PMID: 35084377 DOI: 10.1097/gme.0000000000001895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE High placebo response can often mask the evaluation of active treatment in clinical studies for women with hot flashes and potentially undermine the evaluation of new treatments. OBJECTIVE The aim of this meta-analysis was to determine the factors associated with high placebo response (defined as the reduction in the mean number of hot flash frequency from baseline) in randomized, controlled, double-blind studies enrolling women with hot flashes. EVIDENCE REVIEW To identify eligible studies, Embase, MEDLINE, and BIOSIS Previews were searched for English-language articles published between April 1975 and August 2020. Placebo-controlled, double-blind, randomized studies that assessed changes in hot flash frequency were included if they satisfied the defined criteria. We conducted univariate and multivariate analyses using categorical and numerical data. Categorical data included the following variables and levels in brackets: active treatment type (hormone therapy /non- hormone therapy /complementary and alternative medicine), administration route (oral/non-oral), study region (in/excluded the US), breast cancer population (in/excluded), entry criteria of hot flash severity (moderate to severe only/all included), parallel or crossover study, placebo run-in period before treatment (yes/no), and menopausal status (postmenopausal only/include perimenopausal/include premenopausal). Numerical data included published year, pretreatment period duration, treatment period duration, number of sites, number of total participants, number of placebo participants, number of treatment arms, mean age, BMI, and hot flash frequency at baseline. FINDINGS Forty-three of the 802 identified publications were included in the review. Multivariate analysis identified three individual factors associated with high placebo response: treatment period duration, number of treatment arms, and BMI. CONCLUSIONS AND RELEVANCE We identified several factors associated with high placebo response in clinical studies of women with hot flashes. Knowing these factors may enable proactive implementation of operational and analytic strategies that further aid in determining the true treatment effect of an intervention.
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Affiliation(s)
- Kentaro Miyazaki
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan
- Astellas Pharma Inc, Tokyo, Japan
| | - Masayuki Kaneko
- Department of Hospital Pharmaceutics, School of Pharmaceutical Sciences, Showa University, Tokyo, Japan
| | - Mamoru Narukawa
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan
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A multicenter, randomized study to select the minimum effective dose of estetrol (E4) in postmenopausal women (E4Relief): part 1. Vasomotor symptoms and overall safety. ACTA ACUST UNITED AC 2021; 27:848-857. [PMID: 32379217 PMCID: PMC7386865 DOI: 10.1097/gme.0000000000001561] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective: The aim of this study was to select the minimum effective dose of estetrol (E4) for the treatment of vasomotor symptoms in postmenopausal women. Methods: This was a multicenter, randomized, double-blind, placebo-controlled study. Postmenopausal women (n = 257, of whom 32 were hysterectomized) aged 40 to 65 years, with ≥7 moderate to severe hot flushes (HFs) per day, or 50 or more moderate to severe HFs weekly, received 2.5, 5, 10, or 15 mg E4, or placebo once-daily for a period of 12 weeks. Efficacy was assessed by recording the frequency and severity of HFs. Overall safety was assessed by recording adverse events, measuring endometrial thickness, and monitoring bleeding patterns. Treatment groups were compared using analysis of covariance. Results: The frequency of moderate to severe HFs decreased with all E4 doses. The difference in the percentage change of weekly HF frequency was significant for 15 mg E4 versus placebo at both W4 (−66% vs −49%, P = 0.032) and W12 (−82% vs −65%, P = 0.022). The decrease in severity of HFs was significantly more pronounced for 15 mg E4 than for placebo at both W4 (−0.59 vs −0.33, P = 0.049) and W12 (−1.04 vs −0.66, P = 0.049); the other doses failed to achieve statistical significance. In nonhysterectomized women, endometrial thickness increased during treatment and normalized following progestin treatment at study completion. No endometrial hyperplasia was observed. Conclusions: Estetrol 15 mg is considered to be the minimum effective daily oral dose for treatment of vasomotor symptoms. Its current seemingly favorable safety profile is further to be confirmed in phase 3 clinical development. Video Summary:.
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Kanadys W, Barańska A, Błaszczuk A, Polz-Dacewicz M, Drop B, Kanecki K, Malm M. Evaluation of Clinical Meaningfulness of Red Clover ( Trifolium pratense L.) Extract to Relieve Hot Flushes and Menopausal Symptoms in Peri- and Post-Menopausal Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2021; 13:nu13041258. [PMID: 33920485 PMCID: PMC8069620 DOI: 10.3390/nu13041258] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 12/18/2022] Open
Abstract
The meta-analysis presented in this article covered the efficacy of red clover isoflavones in relieving hot flushes and menopausal symptoms in perimenopausal and postmenopausal women. Studies were identified by MEDLINE (PubMed), Embase, and the Cochrane Library searches. The quality of the studies was evaluated according to Cochrane criteria. A meta-analysis of eight trials (ten comparisons) demonstrated a statistically significant reduction in the daily incidence of hot flushes in women receiving red clover compared to those receiving placebo: weighted mean difference (WMD—weighted mean difference) −1.73 hot flushes per day, 95% CI (confidence interval) −3.28 to −0.18; p = 0.0292. Due to 87.34% homogeneity, the performed analysis showed substantive difference in comparisons of postmenopausal women with ≥5 hot flushes per day, when the follow-up period was 12 weeks, with an isoflavone dose of ≥80 mg/day, and when the formulations contained a higher proportion of biochanin A. The meta-analysis of included studies assessing the effect of red clover isoflavone extract on menopausal symptoms showed a statistically moderate relationship with the reduction in the daily frequency of hot flushes. However, further well-designed studies are required to confirm the present findings and to finally determine the effects of red clover on the relief of flushing episodes.
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Affiliation(s)
- Wiesław Kanadys
- Department of Informatics and Medical Statistics, Medical University of Lublin, 20-090 Lublin, Poland; (W.K.); (B.D.); (M.M.)
| | - Agnieszka Barańska
- Department of Informatics and Medical Statistics, Medical University of Lublin, 20-090 Lublin, Poland; (W.K.); (B.D.); (M.M.)
- Correspondence:
| | - Agata Błaszczuk
- Department of Virology with SARS Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (A.B.); (M.P.-D.)
| | - Małgorzata Polz-Dacewicz
- Department of Virology with SARS Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (A.B.); (M.P.-D.)
| | - Bartłomiej Drop
- Department of Informatics and Medical Statistics, Medical University of Lublin, 20-090 Lublin, Poland; (W.K.); (B.D.); (M.M.)
| | - Krzysztof Kanecki
- Department of Social Medicine and Public Health, Warsaw Medical University, 02-007 Warsaw, Poland;
| | - Maria Malm
- Department of Informatics and Medical Statistics, Medical University of Lublin, 20-090 Lublin, Poland; (W.K.); (B.D.); (M.M.)
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Kauffman RP, Young C, Castracane VD. Perils of prolonged ovarian suppression and hypoestrogenism in the treatment of breast cancer: Is the risk of treatment worse than the risk of recurrence? Mol Cell Endocrinol 2021; 525:111181. [PMID: 33529690 DOI: 10.1016/j.mce.2021.111181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/04/2021] [Accepted: 01/21/2021] [Indexed: 01/18/2023]
Abstract
Premenopausal breast cancer is usually estrogen receptor positive, and hence, prolonged ovarian suppression by medical or surgical means to prevent recurrence has become standard of management to improve disease-free survival. Ten-year adjuvant tamoxifen therapy is associated with 3.5% fewer recurrences compared to five years. The SOFT trial demonstrated small but statistically significant incremental improvements in long-term disease-free survival by the addition of gonadotropin-releasing hormone analog treatment (triptorelin) to an aromatase inhibitor (exemestane). Profound hypoestrogenism in the premenopausal age group may not be well tolerated due to a host of bothersome side effects (primarily vasomotor symptoms, musculoskeletal complaints, genitourinary syndrome of menopause, and mood disorders). Prolonged hypoestrogenism in younger women is associated with premature development of cardiovascular disease, bone loss, cognitive decline, and all-cause mortality. This paper explores multi-system consequences of prolonged hypoestrogenism in premenopausal women derived from studies of women with and without breast cancer. Pretreatment counseling in estrogen receptor positive breast cancer should emphasize the benefit of prolonged estrogen suppression on breast cancer recurrence and established risks of lifelong hypoestrogenism on quality of life and all-cause mortality. Future genomic research may help identify the best candidates for extended ovarian suppression to avoid treating many women when only a minority benefit.
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Affiliation(s)
- Robert P Kauffman
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, School of Medicine, 1400 S. Coulter Rd, Amarillo, TX, 79106, USA.
| | - Christina Young
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, School of Medicine, 1400 S. Coulter Rd, Amarillo, TX, 79106, USA
| | - V Daniel Castracane
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, School of Medicine, 1400 S. Coulter Rd, Amarillo, TX, 79106, USA
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Li T, Zhang Y, Cheng Q, Hou M, Zheng X, Zheng Q, Li L. Quantitative study on the efficacy of acupuncture in the treatment of menopausal hot flashes and its comparison with nonhormonal drugs. Menopause 2021; 28:564-572. [PMID: 33739313 DOI: 10.1097/gme.0000000000001767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare the efficacy of acupuncture to that of sham acupuncture, placebo pills, and nonhormonal drugs to provide the necessary quantitative information for establishing medication guidelines for menopausal hot flashes. METHODS A comprehensive literature search was performed using public databases. Randomized clinical studies on acupuncture therapy for the treatment of hot flashes in menopausal women were identified. A time-course model was established to describe the efficacy characteristics of acupuncture and sham acupuncture, which were compared with the efficacy of nonhormonal drugs and placebo pills reported in the literature. RESULTS A total of 17 studies involving 1,123 participants were included. The quality of all the studies included in the analysis is medium to high, and there was no obvious risk of bias. It was found that the baseline number of hot flashes was an important factor affecting the efficacy of acupuncture and sham acupuncture. After correcting the baseline to eight hot flashes per day, the frequency of hot flashes decreased from baseline for traditional acupuncture (TA), electro-acupuncture (EA), TA&EA (merger analysis of TA and electro-acupuncture), and sham acupuncture were 3.1 (95% confidence interval [CI]: 2.8-3.4), 3.6 (95% CI: 3.2-4.0), 3.2 (95% CI: 2.9-3.5), and 2.6 (95% CI: 2.2-3.0) times/d at week 8, respectively. Compared with findings reported in the literature, we found the efficacy of electro-acupuncture was comparable to that of selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors and neuroleptic agents such as gabapentin and escitalopram. Furthermore, the efficacy of TA&EA (merged) was significantly higher than that of placebo pills (2.3, 95% CI: 1.8-2.9). CONCLUSIONS The efficacy of TA&EA (merged) was higher than that of sham acupuncture and significantly higher than that of placebo pills. The efficacy of electro-acupuncture was higher than that of traditional acupuncture, significantly higher than that of sham acupuncture, and comparable to that of selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors and neuroleptic agents.
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Affiliation(s)
- Ting Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yi Zhang
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qingqing Cheng
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mengyuan Hou
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xijun Zheng
- Zhengzhou University Cancer Hospital and Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Qingshan Zheng
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lujin Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Park EJ, Baek SE, Kim M, Kim AR, Park HJ, Kwon O, Lee JH, Yoo JE. Effects of herbal medicine ( Danggwijagyaksan) for treating climacteric syndrome with a blood-deficiency-dominant pattern: A randomized, double-blind, placebo-controlled pilot trial. Integr Med Res 2021; 10:100715. [PMID: 33665100 PMCID: PMC7903340 DOI: 10.1016/j.imr.2021.100715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 12/18/2022] Open
Abstract
Background Danggwijagyaksan (DJS) has been one of the most widely used herbal medicines for gynecological disorders in traditional East Asian medicine. Several clinical studies about DJS have shown improvement in menopausal symptoms. This pilot study aimed to evaluate the efficacy, safety and feasibility of DJS for treating climacteric syndrome with a blood-deficiency-dominant pattern. Methods This was a randomized, double-blind, placebo-controlled pilot trial. A group of 45-to 60-year-old women with climacteric syndrome were registered for the trial. The participants received treatment over a 4-week period and were then followed for 4 weeks. The primary outcome measure was the mean change in the Menopause Rating Scale (MRS). Secondary outcome measures included the World Health Organization Quality of Life-BREF (WHOQOL-BREF), the Blood-Deficiency Scoring System (BDSS), lean body mass, and serum hormone levels, including follicle-stimulating hormone (FSH) and estradiol (E2) levels. Results The MRS and BDSS scores decreased significantly in both groups, but the differences between two groups were not significant. The WHOQOL-BREF scores increased in the control group. No statistically meaningful differences in serum hormone levels or lean body mass were observed in both groups. There were no serious adverse events, and the laboratory tests were within the normal range. The recruitment rate, completion rate and medication adherence rate were over 90% in both groups, indicating high feasibility. Conclusions DJS showed clinical effectiveness in the treatment of climacteric syndrome with a blood-deficiency-dominant pattern. Additionally, DJS was shown to be safe and feasible for a large-scale study to confirm the efficacy of the treatment. Trial registration: Clinical Research Information Service (CRIS, https://cris.nih.go.kr): KCT0002387.
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Affiliation(s)
- Eun-Ji Park
- Department of Obstetrics and Gynecology, Cheonan Korean Medicine Hospital of Daejeon University, Cheonan, Republic of Korea
| | - Seon-Eun Baek
- Department of Obstetrics and Gynecology, Seoul Korean Medicine Hospital of Daejeon University, Seoul, Republic of Korea
| | - Mikyung Kim
- Department of Internal Medicine, College of Korean Medicine, Sangji University, Wonju, Republic of Korea
| | - Ae-Ran Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Hyo-Ju Park
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ojin Kwon
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jeong-Eun Yoo
- Department of Obstetrics and Gynecology, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
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Kapoor E, Faubion S, Hurt RT, Fischer K, Schroeder D, Fokken S, Croghan IT. A selective serotonin receptor agonist for weight loss and management of menopausal vasomotor symptoms in overweight midlife women: a pilot study. Menopause 2020; 27:1228-1235. [PMID: 33110038 PMCID: PMC7676489 DOI: 10.1097/gme.0000000000001599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Weight gain and vasomotor symptoms (VMS) are common complaints in midlife women going through the menopause transition. A selective serotonin 2C (5-HT2C) receptor agonist, lorcaserin, which was previously approved by the Food and Drug Administration for weight loss, has unreported observational evidence suggesting improvement in VMS with its use. The goal of this pilot study was to evaluate the efficacy of lorcaserin for weight loss and management of VMS in overweight midlife women. METHODS This was a 24-week open label pilot study of 20 overweight midlife women, aged 45-60 years, who were experiencing severe VMS. Participants received lorcaserin at the standard dose of 10 mg twice daily for 12 weeks, followed by 12 weeks of observation off the drug. The primary outcomes were changes in weight and subjectively reported VMS. RESULTS At the end of 12 weeks, mean change in weight was -2.4 kg (90% CI, -3.2 to -1.7, P < 0.001). However, the participants returned to the baseline weight at 24 weeks. Participants also reported significant subjective improvement in VMS, with a mean ± SD change in self-reported hot flash frequency from baseline to week 12 of -5.4 ± 3.9 (decrease of 1.4 standard deviations). There was a rapid increase in the frequency of VMS within 2 weeks of discontinuation of lorcaserin with a tendency to approach the baseline frequency of VMS. CONCLUSIONS In addition to its weight loss-inducing effect, 5-HT2C receptor modulation may have an additional beneficial effect on VMS in midlife women. A treatment option that targets both weight and VMS in midlife women is attractive. : Video Summary:http://links.lww.com/MENO/A622.
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Affiliation(s)
- Ekta Kapoor
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Center for Women’s Health, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Stephanie Faubion
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Center for Women’s Health, Mayo Clinic, Rochester, MN, USA
| | - Ryan T. Hurt
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karen Fischer
- Department of Health Sciences Research, Division of Biosatistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Darrell Schroeder
- Department of Health Sciences Research, Division of Biosatistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Shawn Fokken
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ivana T. Croghan
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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Estetrol for menopause symptoms: the Cinderella of estrogens or just another fairy tale? Menopause 2020; 27:841-843. [PMID: 32576802 DOI: 10.1097/gme.0000000000001601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Liu J, Nie G, Li Y, Wen Z, Lu L, Xie L, Cao D, Lai Y, Yang H. Nonhormonal Hot Flash Management for Breast Cancer Survivors: A Systematic Review and Network Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:4243175. [PMID: 32419803 PMCID: PMC7204350 DOI: 10.1155/2020/4243175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 11/22/2022]
Abstract
MATERIALS AND METHODS We conducted a systematic literature search in PubMed, Cochrane Central Register of Controlled Trials, Embase, Chinese Biomedicine Database (CBM), China National Knowledge Infrastructure (CNKI), Wan Fang, and VIP up to May 2018. Randomized controlled trials (RCTs) reporting nonhormonal hot flash treatments for breast cancer survivors were included. Primary outcome measurements were hot flash frequency and hot flash score of posttreatment. The methodological quality of each study was assessed with Cochrane's risk of bias tool. RESULTS 16 RCTs involving 2,349 participants were included. The nonhormonal therapies used in the included studies were classified as follows: lifestyle changes, mind-body techniques, dietary/supplements, SSRIs/SNRIs, other medications, and other therapies. Pairwise meta-analysis showed that the general effect of nonhormonal management was statistically more effective than no treatment/placebo/sham in reducing hot flash frequency (SMD = -0.60, 95% CI [-1.13, -0.06]; P=0.03)) and hot flash score (SMD = -0.38, 95% CI [-0.68, -0.08]). For hot flash frequency, results from the NMA showed that there was no statistically significant difference between any two of the nonhormonal treatments. Another NMA result indicated that acupuncture (other therapies) was 16.05 points more effective in reducing hot flash scores than no treatment/waitlist (SMD = -16.05, 95% CI [-30.2, -1.99]). These results were statistically significant. Acupuncture was also ranked the optimal nonhormonal therapy for both hot flash frequency and hot flash score. The safety analysis showed that there were few related adverse events during acupuncture and that drug related adverse reactions could have also occurred in studies using drug interventions. CONCLUSIONS This network meta-analysis comparing nonhormonal treatments suggested that acupuncture might be more effective in improving hot flashes for breast cancer survivors. A pronounced placebo response was found during hot flash treatments. The evidence of safety for nonhormonal therapies was also insufficient. Therefore, at present, we cannot make confirmative recommendations of nonhormonal hot flash management for breast cancer survivors. This study is registered with PROSPERO (CRD42018082008).
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Affiliation(s)
- Jian Liu
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road, Yuexiu District, Guangzhou 510120, Guangdong, China
| | - Guangning Nie
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road, Yuexiu District, Guangzhou 510120, Guangdong, China
| | - Yang Li
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road, Yuexiu District, Guangzhou 510120, Guangdong, China
| | - Zehuai Wen
- Key Unit of Methodology in Clinical Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Liming Lu
- Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Li Xie
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Dongdong Cao
- Department of Chinese Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Yafang Lai
- Department of Gynecology, Foshan Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Hongyan Yang
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road, Yuexiu District, Guangzhou 510120, Guangdong, China
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Borba CM, Ferreira CF, Ferreira FV, Pérez-López FR, Wender MCO. Effect of sulpiride on menopausal hot flashes: a randomized, double-blind, placebo-controlled clinical trial. Gynecol Endocrinol 2020; 36:247-251. [PMID: 31476924 DOI: 10.1080/09513590.2019.1658189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Low doses of sulpiride have been used off-label to treat menopausal hot slashes in Southern Brazil despite limited scientific evidence. This randomized controlled trial aimed at assessing the effects of sulpiride as compared to placebo on the frequency and severity of hot flashes. Postmenopausal women, aged 47-62, were recruited from the Menopause Clinic at Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil, between March 2016 and January 2017. After a baseline assessment of 4 weeks, women were included if they had at least a mean of five moderate to severe hot flashes per day and then randomized to receive for 8 weeks either placebo (n= 14) or sulpiride 50 mg/d (n= 14). The number and severity of hot flashes were evaluated after the 8-week intervention. A generalized estimating equations (GEE) model with Bonferroni correction was used to simultaneously assess the frequency and severity of hot flashes. Baseline frequency and severity of hot flashes/day were similar in both groups. Sulpiride significantly reduced the total weekly mean of hot flash frequency (GEE, pinteraction=.019) and the total weekly mean of severity scores (GEE, pinteraction=.09, pgroup=.006, ptime≤.0001) after 4 and 8 weeks of treatment. Treatment with sulpiride 50 mg/d significantly reduced the frequency and severity of hot flashes. Further studies are needed to confirm its benefits and related mechanisms of action.
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Affiliation(s)
- Clarissa Moreira Borba
- Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia, Grupo de Pesquisa: Climatério e Menopausa, Serviço de Ginecologia e Obstetrícia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brasil
| | - Charles Francisco Ferreira
- Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia, Grupo de Pesquisa: Climatério e Menopausa, Serviço de Ginecologia e Obstetrícia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brasil
| | - Fernanda Vargas Ferreira
- Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia, Grupo de Pesquisa: Climatério e Menopausa, Serviço de Ginecologia e Obstetrícia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brasil
| | - Faustino R Pérez-López
- Department of Obstetrics and Gynecology, Faculty of Medicine, Aragón Health Research Institute, University of Zaragoza, Zaragoza, Spain
| | - Maria Celeste Osório Wender
- Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia, Grupo de Pesquisa: Climatério e Menopausa, Serviço de Ginecologia e Obstetrícia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brasil
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Upreti VV, Venkatakrishnan K. Model‐Based Meta‐Analysis: Optimizing Research, Development, and Utilization of Therapeutics Using the Totality of Evidence. Clin Pharmacol Ther 2019; 106:981-992. [DOI: 10.1002/cpt.1462] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/21/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Vijay V. Upreti
- Clinical Pharmacology Modeling and SimulationAmgen Inc. South San Francisco California USA
| | - Karthik Venkatakrishnan
- Quantitative Clinical PharmacologyTakeda Pharmaceuticals International Co. Cambridge Massachusetts USA
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Hot flashes: treating the mind, body and soul. Menopause 2019; 26:461-462. [DOI: 10.1097/gme.0000000000001314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Quantitative comparison of drug efficacy in treating hot flashes in patients with breast cancer. Breast Cancer Res Treat 2018; 173:511-520. [PMID: 30390215 DOI: 10.1007/s10549-018-5029-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/26/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study aimed to quantitatively evaluate drug efficacy and identify relevant factors that affect the relief of hot flashes in patients with breast cancer. METHODS A comprehensive literature search was performed using public databases. Randomized clinical studies on drug therapy for the treatment of hot flashes in patients with breast cancer were identified. A time-effect model was established, and crucial pharmacodynamic parameters, such as maximal efficacy (Emax) and onset time (ET50), were used to reflect the differences in efficacy among the drugs. RESULTS Eighteen studies involving 5178 subjects were included. It was found that the baseline of hot flashes was an important factor for the Emax value of drugs. After correcting the baseline to the level of eight times per day, the Emax values of progesterone, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors (SSRIs/SNRIs), neuroleptic agents, tibolone, phytoestrogen, other types of drugs, and placebo were 8.3(95%CI 6.8, 9.9),5.1(95%CI 4.4, 5.7), 4.4(95%CI 3.6, 5.3), 4.0(95%CI 3.6, 4.3), 3.4(95%CI 2.4, 4.3), 2.5(95%CI 0.8, 4.2), and 2.7(95%CI 2.1, 3.3), respectively. The ET50 of all the drugs were approximately 2-2.5 weeks, which was obviously longer than that of the placebo (1.2 weeks). When compared with the previously reported efficacy characteristics in natural menopausal women, no significant difference was found between the two populations. CONCLUSIONS Progesterone showed the highest efficacy, followed by SSRIs/SNRIs, neuroleptic agents, and tibolone, while phytoestrogen and other types of drugs showed no efficacy advantages. There is a significant association between the baseline of hot flashes and drug efficacy, while there was no significant difference between breast cancer patients and natural menopausal women.
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McGarry K, Geary M, Gopinath V. Beyond Estrogen: Treatment Options for Hot Flashes. Clin Ther 2018; 40:1778-1786. [DOI: 10.1016/j.clinthera.2018.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/16/2018] [Accepted: 08/18/2018] [Indexed: 11/17/2022]
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