本系统评价的目的是评估在妊娠早期或中期药物终止妊娠之前用来曲唑预处理的疗效。
我们搜索了来曲唑,femara,芳香化酶抑制剂,堕胎代理人,MEDLINE终止妊娠和引产,EMBASE,Cochrane数据库,GoogleScholar和PubMed从每个数据库开始到2015年9月,没有语言限制。对所有随机对照试验(RCT)进行了系统评价,其中妇女接受来曲唑和米索前列醇或安慰剂和米索前列醇终止妊娠。主要结果是完全流产率,定义为从子宫中完全排出受孕产物。使用95%置信区间的相对危险度报告数据。
我们的系统评价确定了7项研究;4项RCTs被纳入评价。两项随机对照试验评估了妊娠直至9周的终止妊娠,而2人评估了妊娠9周的终止妊娠。对于每个胎龄组,一项试验支持提高完全流产率,而另一个没有区别,与安慰剂和米索前列醇相比,来曲唑和米索前列醇。在米索前列醇中加入来曲唑后,终止妊娠至妊娠9周的流产时间间隔没有改善。对于妊娠9周以上的终止妊娠,一项试验支持,一项试验驳斥了来曲唑和米索前列醇对流产时间间期缩短的影响.同样,对于每个胎龄组,一项研究支持降低,一项研究显示来曲唑和米索前列醇的扩张和刮治率(D&C)没有差异。两个治疗组之间的药物副作用相似。试验之间存在显著的异质性,因此,结果未进行荟萃分析.
一些研究和试验报告了更好的结果(即,完全流产率,与安慰剂和米索前列醇相比,暴露于来曲唑和米索前列醇的女性的流产时间和D&C率),而其他试验表明没有差异。需要进一步研究探索来曲唑在药物流产前的预处理。
本系统综述表明,在某些研究中,与单独使用米索前列醇相比,来曲唑和米索前列醇的组合可提高完全流产率,而在其他研究中却没有;还需要设计良好的RCT。
The purpose of this systematic
review was to evaluate the efficacy of pretreatment with letrozole prior to either a first- or second-trimester medical termination of pregnancy.
We searched letrozole, femara, aromatase inhibitors, abortifacient agents, termination of pregnancy and labor induction in MEDLINE, EMBASE, Cochrane Database, Google Scholar and PubMed from inception of each database until September 2015 with no language limitation. A systematic
review of all randomized controlled trials (RCTs) was performed where women received either letrozole and misoprostol or placebo and misoprostol for termination of pregnancy. The primary outcome was complete abortion rate, defined as complete evacuation of the products of conception from the uterus. Relative risk with 95% confidence intervals was used to report data.
Our systematic
review identified 7 studies; 4 RCTs were included in the
review. Two RCTs evaluated terminations of pregnancy up to 9 weeks\' gestation, while 2 evaluated terminations over 9 weeks\' gestation. For each gestational age group, one trial supported an increase in complete abortion rate, while the other showed no difference, with letrozole and misoprostol compared with placebo and misoprostol. Time-to-abortion interval for terminations up to 9 weeks\' gestation was not improved with the addition of letrozole to misoprostol. For terminations over 9 weeks\' gestation, one trial supported and one trial refuted a decrease in time-to-abortion interval with letrozole and misoprostol. Similarly, for each gestational age group, one study supported a decrease and one study showed no difference in rate of dilation and curettage (D&C) with letrozole and misoprosol. Medication side effects were similar between both treatment groups. There was significant heterogeneity between the trials, and therefore, the results were not meta-analyzed.
Some studies and trials report better outcomes (i.e., complete abortion rates, time-to-abortion and D&C rates) in women exposed to letrozole and misoprostol compared to placebo and misoprostol, while other trials demonstrate no difference. Further research exploring letrozole pretreatment prior to medical abortion is required.
This systematic
review demonstrated that a combination of letrozole and misoprostol increased the rate of complete abortion compared to misoprostol alone in some studies but not in others; additional well-designed RCT\'s are needed.