Effects of clomiphene citrate and anastrozole as a combination therapy for hypogonadism: A systematic review and meta-analysis
Clomiphene citrate (CC) and anastrozole (AZ) combination has been used off-label to improve spermatogenesis in male infertility. This systematic literature review and meta-analysis evaluated the efficacy and safety of CC and AZ combination therapy in subfertile hypogonadal men. Studies were systemat...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2024-01-01
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| Series: | Annals of Medical Science and Research |
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| Online Access: | https://journals.lww.com/10.4103/amsr.amsr_30_23 |
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| author | Padmashobana Bagavathithasan Swati Sucharita Dash Lakshmi Venkatachalam Vaishali Amol Shetye Shashwati Pankaj Jignesh Bhate Guruprasad K S Rao |
| author_facet | Padmashobana Bagavathithasan Swati Sucharita Dash Lakshmi Venkatachalam Vaishali Amol Shetye Shashwati Pankaj Jignesh Bhate Guruprasad K S Rao |
| author_sort | Padmashobana Bagavathithasan |
| collection | DOAJ |
| description | Clomiphene citrate (CC) and anastrozole (AZ) combination has been used off-label to improve spermatogenesis in male infertility. This systematic literature review and meta-analysis evaluated the efficacy and safety of CC and AZ combination therapy in subfertile hypogonadal men. Studies were systematically searched and retrieved from PubMed, Web of Science, CENTRAL, and ClinicalTrials.gov from inception to May 19, 2021, using MeSH terms/keywords. Statistical analysis was performed using a random effects model, pooled risk ratio, and heterogeneity (I2). The methodological quality of the studies was assessed utilizing the Newcastle–Ottawa Scale and Moga tools. Overall, 37 studies were identified from a systematic search, and two studies that met the eligibility criteria were considered for quantitative synthesis. Treatment with combination therapy (CC + AZ) and monotherapy (CC) significantly increased the total testosterone (TT), bioavailable testosterone (BT), estradiol level, and testosterone/estradiol (T/E) ratio from baseline (P < 0.00001). In comparison with monotherapy, combination therapy increased TT (mean difference [MD]: 56.29; 95% confidence interval [CI], 12.36, 100.22; P = 0.01) and BT (MD: 48.18; 95% CI, 8.19, 88.17; P = 0.02) levels in blood. Monotherapy elevated the estradiol level and decreased T/E ratio, whereas combination therapy reduced the estradiol (MD: -2.17; 95% CI, -59.89, 55.55; P = 0.94) level and optimized T/E ratio (MD: 3.64; 95% CI, -18.90, 26.18; P = 0.75). P-specific antigen and hematocrit levels were measured to evaluate the safety of combination and monotherapy. Combination therapy with CC and AZ was safe and well-tolerated in hypogonadal men. |
| format | Article |
| id | doaj-art-c51c531946bc4e3aae0c68d5dc9c0da6 |
| institution | Kabale University |
| issn | 2949-785X |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Medical Science and Research |
| spelling | doaj-art-c51c531946bc4e3aae0c68d5dc9c0da62025-08-20T03:59:36ZengWolters Kluwer Medknow PublicationsAnnals of Medical Science and Research2949-785X2024-01-013111010.4103/amsr.amsr_30_23Effects of clomiphene citrate and anastrozole as a combination therapy for hypogonadism: A systematic review and meta-analysisPadmashobana BagavathithasanSwati Sucharita DashLakshmi VenkatachalamVaishali Amol ShetyeShashwati PankajJignesh BhateGuruprasad K S RaoClomiphene citrate (CC) and anastrozole (AZ) combination has been used off-label to improve spermatogenesis in male infertility. This systematic literature review and meta-analysis evaluated the efficacy and safety of CC and AZ combination therapy in subfertile hypogonadal men. Studies were systematically searched and retrieved from PubMed, Web of Science, CENTRAL, and ClinicalTrials.gov from inception to May 19, 2021, using MeSH terms/keywords. Statistical analysis was performed using a random effects model, pooled risk ratio, and heterogeneity (I2). The methodological quality of the studies was assessed utilizing the Newcastle–Ottawa Scale and Moga tools. Overall, 37 studies were identified from a systematic search, and two studies that met the eligibility criteria were considered for quantitative synthesis. Treatment with combination therapy (CC + AZ) and monotherapy (CC) significantly increased the total testosterone (TT), bioavailable testosterone (BT), estradiol level, and testosterone/estradiol (T/E) ratio from baseline (P < 0.00001). In comparison with monotherapy, combination therapy increased TT (mean difference [MD]: 56.29; 95% confidence interval [CI], 12.36, 100.22; P = 0.01) and BT (MD: 48.18; 95% CI, 8.19, 88.17; P = 0.02) levels in blood. Monotherapy elevated the estradiol level and decreased T/E ratio, whereas combination therapy reduced the estradiol (MD: -2.17; 95% CI, -59.89, 55.55; P = 0.94) level and optimized T/E ratio (MD: 3.64; 95% CI, -18.90, 26.18; P = 0.75). P-specific antigen and hematocrit levels were measured to evaluate the safety of combination and monotherapy. Combination therapy with CC and AZ was safe and well-tolerated in hypogonadal men.https://journals.lww.com/10.4103/amsr.amsr_30_23anastrozoleclomiphene citratehypogonadismestradioltestosterone |
| spellingShingle | Padmashobana Bagavathithasan Swati Sucharita Dash Lakshmi Venkatachalam Vaishali Amol Shetye Shashwati Pankaj Jignesh Bhate Guruprasad K S Rao Effects of clomiphene citrate and anastrozole as a combination therapy for hypogonadism: A systematic review and meta-analysis Annals of Medical Science and Research anastrozole clomiphene citrate hypogonadism estradiol testosterone |
| title | Effects of clomiphene citrate and anastrozole as a combination therapy for hypogonadism: A systematic review and meta-analysis |
| title_full | Effects of clomiphene citrate and anastrozole as a combination therapy for hypogonadism: A systematic review and meta-analysis |
| title_fullStr | Effects of clomiphene citrate and anastrozole as a combination therapy for hypogonadism: A systematic review and meta-analysis |
| title_full_unstemmed | Effects of clomiphene citrate and anastrozole as a combination therapy for hypogonadism: A systematic review and meta-analysis |
| title_short | Effects of clomiphene citrate and anastrozole as a combination therapy for hypogonadism: A systematic review and meta-analysis |
| title_sort | effects of clomiphene citrate and anastrozole as a combination therapy for hypogonadism a systematic review and meta analysis |
| topic | anastrozole clomiphene citrate hypogonadism estradiol testosterone |
| url | https://journals.lww.com/10.4103/amsr.amsr_30_23 |
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