The use of cyproterone acetate/ethinyl estradiol in hyperandrogenic skin symptoms – a review

Abstract

Introduction: Hyperandrogenism affects approximately 10-20% of women of reproductive age. Hyperandrogenic skin symptoms such as hirsutism, acne, seborrhea and alopecia are associated with significant quality of life and psychological impairment. Women with abnormalities in androgen metabolism may have accompanying anovulation and/or polycystic ovary syndrome (PCOS), both of which have reproductive and metabolic implications if left untreated. Cyproterone acetate (CPA), combined with ethinylestradiol (EE), is indicated for the treatment of moderate to severe acne related to androgen-sensitivity (with or without seborrhea) and/or hirsutism, in women of reproductive age. Objective: To review the data on the efficacy and safety of CPA 2 mg/EE 35 lg for the treatment of hyperandrogenic skin symptoms in women. Methods: A non-systematic narrative review based on a literature search of the PubMed database. Results: Seventy-eight studies were identified. The majority of sufficiently powered studies show a high efficacy of CPA 2 mg/EE 35 lg in the treatment of severe acne and hirsutism. Studies show that therapeutic response in women with hirsutism requires a long-term approach and that hyperandrogenic skin symptoms in patients with PCOS are efficiently treated. Additional benefits include cycle control and, in some women, improvement in mood and perception of body image. Safety and tolerability data are summarized by the pharmacovigilance risk assessment committee (PRAC) of the European Medicine's Agency's (EMA). Conclusions: This review provides a comprehensive overview about the efficacy of CPA 2 mg/EE 35 lg in the treatment of hyperandrogenic skin symptoms, thus allowing both health care professionals and women to balance the risks and benefits of treatment based on evidence.

Mechanisms of Androgen Receptor Agonist- and Antagonist-Mediated Cellular Senescence in Prostate Cancer

“…Since CPA has partial AR agonistic activity and is known as a mild AR antagonist, it is meanwhile rarely used in PCa hormone therapy [66]. Rather, CPA is clinically more used as birth control pills and in the treatment of androgen-dependent conditions such as acne and excessive hair growth [67]. CPA antagonism is dependent on co-repressor binding to the AR.…”

Use of cyproterone acetate/ethinylestradiol in polycystic ovary syndrome: rationale and practical aspects

“…Clinical trials (mostly open-label comparator studies conducted between 1985 and 2012) show a high efficacy of CPA/EE in the treatment of hyperandrogenic skin symptoms in women with PCOS as discussed in the accompanying publication. The use of CPA/EE in hyperandrogenic skin symptoms -A review [49].…”

“…The risk of VTE is generally reported to be higher with CPA/EE than with o pre-treatment may improve pregnancy outcomes (further studies needed) Figure 6. Benefits of CPA/EE in the treatment PCOS [37,49,51,[73][74][75].…”

Consensus statement on the use of oral contraceptive pills in polycystic ovarian syndrome women in India

“…[ 100 ] A nonsystematic narrative review based on a literature search of the PubMed database showed high efficacy of CPA 2 mg/EE 35 μg in the treatment of severe acne and hirsutism. [ 111 ]…”