مقایسه اثربخشی لتروزول و کلومیفن سیترات در زنان نابارور ایرانی: مرور سیستماتیک و متاآنالیز

نوع مقاله : مروری

نویسندگان

1 کارشناس ارشد مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی البرز، کرج، ایران.

2 دانشجوی دکتری تخصصی بیولوژی تولید مثل، دانشکده پزشکی، دانشگاه علوم پزشکی تهران، تهران، ایران.

3 کارشناس ارشد مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

4 دکترای سلامت باروری، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی قزوین، قزوین، ایران

چکیده

مقدمه: یکی از متداول­ترین روش­های درمانی در ناباروری، استفاده از داروهای خوراکی مانند کلومیفن سیترات و لتروزول است. میزان موفقیت کلومیفن در زنان مبتلا به سندرم تخمدان پلی‌کیستیک و مقاومت به انسولین نسبت به سایرین پایین‌تر است، اما لتروزل نتایج موفقیت‌آمیزی در این گروه‌ها داشته است، اما به دلیل قیمت بالاتر لتروزول، کلومیفن هنوز در بسیاری از موارد به عنوان خط اول درمان استفاده می‌شود. مطالعه حاضر با هدف بررسی اثربخشی این دو داروی اولیه مهم در درمان ناباروری انجام شد.
روش‌کار: در این مطالعه مرور سیستماتیک جهت یافتن مقالات، بانک­های اطلاعاتی فارسی و انگلیسی Magiran، Medlib، SID، pubmed، Cochrane، Irandoc، IranMedex و Google scholar جهت بازیابی مقالات فارسی و انگلیسی، بدون محدودیت زمانی تا ابتدای اردیبهشت سال 1398 (می 2019) جستجو شدند. جستجوی جامع با کلید واژه­های فارسی داروهای ناباروری، کلومیفن سیترات، لتروزول، ایران و معادل­های انگلیسی متناسب انجام شد. مقالات کارآزمایی بالینی تصادفی شده، دارای متن کامل که به مقایسه عملکرد دو داروی کلومیفن سیترات و لتروزول در ناباروری پرداخته بودند، وارد مطالعه شدند.
یافته‌ها: در ابتدا 627 مقاله بازیابی شد که پس از حذف موارد تکراری (164 مقاله) و غیرمرتبط (463 مقاله)، متن کامل 41 مقاله بررسی شد. از بین مقالات بازیابی شده، 19 مقاله واجد شرایط ورود به مطالعه بودند.19 کارآزمایی بالینی با مشارکت 2638 بیمار در این مطالعه وارد شدند.نتایج متاآنالیز نشان داد که در گروه لتروزول نسبت به کلومیفن سیترات شانس بارداری 10%، همچنین شانس تولد نوزاد زنده در گروه لتروزول 2/11% و میانگین ضخامت آندومتر بیشتر از کلومیفن بود. شانس سندرم تحریک بیش از حد تخمدان 4/1%، سقط 6/0% و بارداری چندقلو 4/4% و میانگین تعداد فولیکول غالب در گروه لتروزل نسبت به کلومیفن سیترات کمتر بود. بر اساس نتایج نمودار قیفی و آزمونegger ، سوگرایی انتشار وجود نداشت (43/0=p).
نتیجه‌گیری: هرچند قیمت لتروزول از کلومیفن سیترات بالاتر است، اما لتروزول در دستیابی و موفقیت در بارداری نتایج امیدوارکننده‌تری داشته است، با این‌حال نیاز به مطالعات وسیع‌تر در این زمینه وجود دارد.

کلیدواژه‌ها

عنوان مقاله [English]

Comparison of the efficacy of Letrozole versus Clomiphene Citrate among Iranian infertile females: A systematic review and meta-analysis

نویسندگان [English]

  • Zeinab Talebi Tamajani 1
  • Seyed Danial Mohammadi 2
  • Maryam Gorji 3
  • Zeinab Alimoradi 4
1 M.Sc. in Midwifery, Faculty of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
2 Ph.D Candidate in Reproductive Biology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
3 M.Sc. in Midwifery, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
4 Ph.D in Reproductive Health, Social Determinants of Health Research Center (SDH), School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
چکیده [English]

Introduction: One of the most common infertility treatment is oral medications, such as clomiphene citrate and letrozole. The clomiphene success rate is low among women with polycystic ovary syndrome and insulin resistance. However, letrozole overall success rate was high in these patients. Due to the higher price of letrozole, clomiphene is still the first-line therapy for this condition. This study aimed to systematically compare the efficacy of letrozole with clomiphene citrate in Iranian infertile females.
Method: Databases, including Magiran، Medlib، SID، PubMed، Cochrane، Irandoc، IranMedex, and Google Scholar were systematically reviewed to retrieve original research articles in both Persian and English language without time limit until May 2019. The comprehensive search was conducted using Persian keywords of infertility drugs, such as clomiphene citrate, letrozole, as well as Iran, and their English equivalents. Randomized controlled trials (RCT) with full texts which compared the effect of letrozole and clomiphene citrate on infertility were included in this study.
Results: Initially، 627 articles were retrieved. After removing duplicated (164) and irrelevant (463) articles، 41 full texts were further assessed in this study. Finally, 19 articles were found eligible to be included in this systematic review. In total, this study was conducted using 19 eligible RCTs involving 2638 patients. The results of the meta-analysis revealed that pregnancy rate (10%), chance of live birth (11.2%), and mean thickness of the endometrium were significantly higher in the letrozole group, compared to those in clomiphene citrate group. On the other hand, the chance of ovarian hyperstimulation syndrome (1.4%), mean number of dominant follicles (0.179), abortion (0.6%), and multiple pregnancies (4.4%) were lower in the letrozole group, compared to those in clomiphene citrate group. The results of the funnel plot and egger tests (P=0.43) confirmed no publication bias.
Conclusions: Although letrozole is more expensive than clomiphene citrate، it had more promising results in achieving pregnancy with fewer side effects. However, more extensive studies are needed in this regard.

کلیدواژه‌ها [English]

  • Clomiphene citrate
  • Infertility
  • Iran
  • Ovulation stimulation
  • Letrozole

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مجله زنان، مامایی و نازایی ایران
دوره 22، شماره 7
مهر 1398
صفحه 89-102

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