Cochrane: GnRH agonists protect ovaries during chemotherapy

  • Chen H & al.
  • Cochrane Database Syst Rev
  • 3 Mar 2019

  • International Clinical Digest
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Takeaway

  • A Cochrane systematic review concludes that gonadotropin-releasing hormone (GnRH) agonists are effective for maintenance/resumption of menstruation, ovulation, and prevention of premature ovarian failure among premenopausal women undergoing chemotherapy.

Why this matters

  • Chemotherapy is associated with ovarian toxicity.

Key results

  • GnRH agonist was associated with improved rates of menstruation recovery or maintenance compared with control patients in follow-up ≤12 months (74.5% vs 50.0%; risk ratio [RR], 1.60; P=.006), although not in follow-up >12 months (72.9% vs 65.4%; RR, 1.08; 95% CI, 0.95-1.22).
  • GnRH agonist was associated with reduced incidence of premature ovarian failure (10.7% vs 25.3%; RR, 0.44; P<.00001 and higher incidence of ovulation vs>
  • Pooled safety analysis showed similar adverse effects between GnRH agonist and control groups.

Study design

  • 1369 women aged 12-51.1 years from 12 randomized controlled trials were included.
  • Participants were diagnosed with breast cancer, ovarian cancer, or Hodgkin's lymphoma; most received alkylating or platinum-based chemotherapy.
  • Funding: West China Secondary Hospital; Cochrane Gynaecological, Neuro-oncology and Orphan Cancers, UK.

Limitations

  • Trials at high or unclear risk for bias.
  • Insufficient evidence for rates of pregnancy and the effects of GnRH agonist-antagonist cotreatment.

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