Indicaciones de la drospirenona más allá de la anticoncepción.

Indications of drospirenone beyond contraception.

Contenido principal del artículo

Franklin José Espitia De La Hoz

Resumen

Introducción: la drospirenona es una progestina de tercera generación, derivada de la espironolactona; la cual goza de actividad anti-mineralocorticoide y antiandrogénica, además de una alta eficacia anticonceptiva. El objetivo de esta revisión consistió en evaluar la efectividad y seguridad de la drospirenona, más allá de sus efectos anticonceptivos. Métodos: se hizo una revisión sistemática de la literatura en las bases de datos electrónicas (Medline vía PubMed, Central, CINAHL, Cochrane Database of Systematic Reviews (plataforma Wiley), entre otras), a través de términos de búsqueda libres y estandarizados. Los desenlaces evaluados incluyeron tratamiento de la endometriosis, síndrome de ovario poliquístico, sangrado uterino disfuncional, síndrome premenstrual y terapia de reemplazo hormonal, así como los efectos adversos. La búsqueda se limitó a artículos y revisiones bibliográficas publicadas a partir de 1990 hasta el 2020, en inglés y español. Resultados: se incluyeron 48 publicaciones. La drospirenona demostró ser eficaz y segura en el tratamiento de condiciones ginecológicas frecuentes como: la endometriosis, síndrome de ovario poliquístico (SOP), sangrado uterino disfuncional, síndrome premenstrual y en la terapia de reemplazo hormonal. Se observó una baja frecuencia de efectos adversos. Conclusiones: la drospirenona es eficaz y segura para el tratamiento de algunas afecciones ginecológicas de frecuente consulta en la práctica diaria, con ventajas adicionales en su régimen 24/4, además de escasa presencia de efectos adversos. Se requiere mayor evidencia más allá de la anticoncepción, para promover su recomendación e indicaciones en la práctica clínica.

Descargas

Los datos de descargas todavía no están disponibles.

Detalles del artículo

Biografía del autor/a (VER)

Franklin José Espitia De La Hoz, Hathor Clínica Sexológica

Dirección científica Hathor Clínica Sexológica, Armenia, Colombia

Palabras clave:

Referencias (VER)

1. Oelkers W. Drospirenone, a progestogen with antimineralocorticoid properties: a short review. Mol Cell Endocrinol. 2004 Mar 31; 217(1-2): 255-61. https://doi.org/10.1016/j.mce.2003.10.030

2. Oelkers WH. Drospirenone in combination with estrogens: for contraception and hormone replacement therapy. Climacteric. 2005 Oct;8 Suppl 3: 19-27. https://doi.org/10.1080/13697130500330341

3. Stanczyk FZ. All progestins are not created equal. Steroids. 2003 Nov; 68(10-13): 879-90. https://doi.org/10.1016/j.steroids.2003.08.003

4. Stacy RA, Nelson AL. A new progestogen-only medical therapy for outpatient management of acute, abnormal uterine bleeding: a pilot sudy. Am J Obstet Gynecol. 2013; 208(6): 499.e1-5. https://doi.org/10.1016/j.ajog.2013.02.013

5. Bhatia SC, Bhatia SK. Diagnosis and treatment of premenstrual dysphoric disorder. Am Fam Physician. 2002 Oct 1; 66(7): 1239-48.

6. Raudrant D, Rabe T. Progestogens with antiandrogenic properties. Drugs. 2003; 63(5): 463-92. https://doi.org/10.2165/00003495-200363050-00003

7. Benagiano G, Pera A, Primiero FM. The endometrium and hormonal contraceptives. Hum. Reprod. 2000; 15(1): 101–18.

8. Deligdisch L. Hormonal pathology of the endometrium. Mod Pathol. 2000 Mar; 13(3): 285-94. https://doi.org/10.1038/modpathol.3880050

9. Elger W, Beier S, Pollow K, Garfield R, Shi SQ, Hillisch A. Conception and pharmacodynamic profile of drospirenone. Steroids. 2003 Nov; 68(10-13): 891-905. https://doi.org/10.1016/j.steroids.2003.08.008

10. Duijkers IJ, Heger-Mahn D, Drouin D, Skouby S. A randomised study comparing the effect on ovarian activity of a progestogen-only pill (POP) containing desogestrel and a new POP containing drospirenone in a 24/4 regimen. Eur J Contracept Reprod Health Care. 2015; 20(6): 419-27. https://doi.org/10.3109/13625187.2015.1044082

11. Archer DF, Ahrendt HJ, Drouin D. Drospirenone-only oral contraceptive: results from a multicenter noncomparative trial of efficacy, safety and tolerability. Contraception. 2015 Nov; 92(5): 439-44. https://doi.org/10.1016/j.contraception.2015.07.014

12. Duijkers IJM, Heger-Mahn D, Drouin D, Colli E, Skouby S. Maintenance of ovulation inhibition with a new progestogen-only pill containing drospirenone after scheduled 24-h delays in pill intake. Contraception. 2016 Apr; 93(4): 303-309. https://doi.org/10.1016/j.contraception.2015.12.007

13. Palacios S, Colli E, Regidor PA. Multicenter, phase III trials on the contraceptive efficacy, tolerability and safety of a new drospirenone-only pill. Acta Obstet Gynecol Scand. 2019 Dec; 98(12): 1549-1557. https://doi.org/10.1111/aogs.13688

14. Roach RE, Helmerhorst FM, Lijfering WM, Stijnen T, Algra A, Dekkers OM. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database Syst Rev. 2015 Aug 27; 2015(8): CD011054. https://doi.org/10.1002/14651858.CD011054.pub2

15. Stegeman BH, de Bastos M, Rosendaal FR, van Hylckama Vlieg A, Helmerhorst FM, Stijnen T, Dekkers OM. Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis. BMJ. 2013 Sep 12; 347: f5298. https://doi.org/10.1136/bmj.f5298

16. Rios LP, Ye C, Thabane L. Association between framing of the research question using the PICOT format and reporting quality of randomized controlled trials. BMC Med Res Methodol. 2010 Feb 5; 10:11. https://doi.org/10.1186/1471-2288-10-11

17. Ministerio de Salud y Protección Social. Resolución 8430 de 1993.

18. Richter WH, Koytchev R, Kirkov V, Merki G, Colli E, Regidor PA. Comparative pharmacokinetic estimates of drospirenone alone and in combination with ethinyl estradiol after single and repeated oral administration in healthy females. Contraception. 2020 Feb; 101(2): 137-143. https://doi.org/10.1016/j.contraception.2019.10.005

19. Schindler AE. Non-contraceptive benefits of oral hormonal contraceptives. Int J Endocrinol Metab. 2013 Winter; 11(1): 41-7. https://doi.org/10.5812/ijem.4158

20. Regidor PA. The clinical relevance of progestogens in hormonal contraception: Present status and future developments. Oncotarget. 2018 Oct 2; 9(77): 34628-34638. https://doi.org/10.18632/oncotarget.26015

21. White WB, Hanes V, Chauhan V, Pitt B. Effects of a new hormone therapy, drospirenone and 17-beta-estradiol, in postmenopausal women with hypertension. Hypertension. 2006 Aug; 48(2): 246-53. https://doi.org/10.1161/01.HYP.0000232179.60442.84

22. Kodaman PH. Current strategies for endometriosis management. Obstet Gynecol Clin North Am. 2015 Mar; 42(1): 87-101. https://doi.org/10.1016/j.ogc.2014.10.005

23. Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril. 2014 Apr; 101(4): 927-35. https://doi.org/10.1016/j.fertnstert.2014.02.012

24. Taniguchi F, Enatsu A, Ota I, Toda T, Arata K, Harada T. Effects of low dose oral contraceptive pill containing drospirenone/ethinylestradiol in patients with endometrioma. Eur J Obstet Gynecol Reprod Biol. 2015; 191: 116-20. https://doi.org/10.1016/j.ejogrb.2015.06.006

25. Pehlivanov B, Mitkov M. Efficacy of an oral contraceptive containing drospirenone in the treatment of women with polycystic ovary syndrome. Eur J Contracept Reprod Health Care. 2007 Mar; 12(1): 30-5. https://doi.org/10.1080/13625180600983082

26. Batukan C, Muderris II. Efficacy of a new oral contraceptive containing drospirenone and ethinyl estradiol in the long-term treatment of hirsutism. Fertil Steril. 2006 Feb; 85(2): 436-40. https://doi.org/10.1016/j.fertnstert.2005.07.1311

27. Guido M, Romualdi D, Giuliani M, Suriano R, Selvaggi L, Apa R, Lanzone A. Drospirenone for the treatment of hirsute women with polycystic ovary syndrome: a clinical, endocrinological, metabolic pilot study. J Clin Endocrinol Metab. 2004 Jun; 89(6): 2817-23. https://doi.org/10.1210/jc.2003-031158

28. van Vloten WA, van Haselen CW, van Zuuren EJ, Gerlinger C, Heithecker R. The effect of 2 combined oral Contraceptives containing either drospirenone or cyproterone acetate on acne and seborrhea. Cutis. 2002 Apr; 69(4 Suppl): 2-15.

29. Lopez LM, Kaptein AA, Helmerhorst FM. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD006586. https://doi.org/10.1002/14651858.CD006586.pub2

30. Pearlstein TB, Bachmann GA, Zacur HA, Yonkers KA. Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation. Contraception. 2005 Dec; 72(6): 414-21. https://doi.org/10.1016/j.contraception.2005.08.021

31. Yonkers KA, Brown C, Pearlstein TB, Foegh M, Sampson-Landers C, Rapkin A. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol. 2005 Sep; 106(3): 492-501. https://doi.org/10.1097/01.AOG.0000175834.77215.2e

32. Farrukh JB, Towriss K, McKee N. Abnormal uterine bleeding: Taking the stress out of controlling the flow. Can Fam Physician. 2015 Aug; 61(8): 693-7.

33. Bradley LD, Gueye NA. The medical management of abnormal uterine bleeding in reproductive-aged women. Am J Obstet Gynecol. 2016 Jan; 214(1): 31-44. https://doi.org/10.1016/j.ajog.2015.07.044

34. Foidart JM, Faustmann T. Advances in hormone replacement therapy: weight benefits of drospirenone, a 17alpha-spirolactone-derived progestogen. Gynecol Endocrinol. 2007 Dec; 23(12): 692-9. https://doi.org/10.1080/09513590701582323

35. Preston RA, Alonso A, Panzitta D, Zhang P, Karara AH. Additive effect of drospirenone/17-beta-estradiol in hypertensive postmenopausal women receiving enalapril. Am J Hypertens. 2002 Sep; 15(9): 816-22. https://doi.org/10.1016/s0895-7061(02)02980-1

36. Bitzer J, Amy JJ, Beerthuizen R, Birkhäuser M, Bombas T, Creinin M, et al. Statement on combined hormonal contraceptives containing third- or fourth-generation progestogens or cyproterone acetate, and the associated risk of thromboembolism. Eur J Contracept Reprod Health Care. 2013 Jun; 18(3): 143-7. https://doi.org/10.3109/13625187.2013.792637

37. Krattenmacher R. Drospirenone: pharmacology and pharmacokinetics of a unique progestogen. Contraception. 2000 Jul; 62(1): 29-38. https://doi.org/10.1016/s0010-7824(00)00133-5

38. Schweppe KW. The current place of progestins in the treatment of endometriosis. Expert Review of Obstetrics & Gynecology. 2012; 7(2):141–18. https://doi.org/10.1586/eog.11.71

39. Fainaru O, Linda C. Giudice, Johannes L. H. Evers, David L. Healy (eds): Endometriosis: Science and Practice: Wiley-Blackwell, Oxford, 2012, 600 pp, ISBN 978-1-4443-3213-1. J Obstet Gynaecol India. 2014 Jun; 64(3): 224–5. https://doi.org/10.1007/s13224-014-0565-9

40. Mathur R, Levin O, Azziz R. Use of ethinylestradiol/drospirenone combination in patients with the polycystic ovary syndrome. Ther Clin Risk Manag. 2008 Apr; 4(2): 487-92. https://doi.org/10.2147/tcrm.s6864

41. Rapkin AJ, McDonald M, Winer SA. Ethinyl estradiol/drospirenone for the treatment of the emotional and physical symptoms of premenstrual dysphoric disorder. Womens Health (Lond). 2007 Jul; 3(4): 395-408. https://doi.org/10.2217/17455057.3.4.395

42. Foidart JM, Wuttke W, Bouw GM, Gerlinger C, Heithecker R. A comparative investigation of contraceptive reliability, cycle control and tolerance of two monophasic oral contraceptives containing either drospirenone or desogestrel. Eur J Contracept Reprod Health Care. 2000 Jun; 5(2): 124-34. https://doi.org/10.1080/13625180008500387

43. Sangthawan M, Taneepanichskul S. A comparative study of monophasic oral contraceptives containing either drospirenone 3 mg or levonorgestrel 150 microg on premenstrual symptoms. Contraception. 2005 Jan; 71(1): 1-7. https://doi.org/10.1016/j.contraception.2004.07.010

44. Archer DF. Drospirenone and estradiol: a new option for the postmenopausal woman. Climacteric. 2007 Feb;10 Suppl 1: 3-10. https://doi.org/10.1080/13697130601114859

45. James AH, Kouides PA, Abdul-Kadir R, Dietrich JE, Edlund M, Federici AB, et al. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel. Eur J Obstet Gynecol Reprod Biol. 2011 Oct; 158(2): 124-34. https://doi.org/10.1016/j.ejogrb.2011.04.025

46. American College of Obstetricians and Gynecologists. Committee Opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013; 121(4): 891–896.

47. Lee BS, Kang BM, Yoon BK, Choi H, Park HM, Kim JG. Efficacy and tolerability of estradiol 1 mg and drospirenone 2 mg in postmenopausal Korean women: a double-blind, randomized, placebo-controlled, multicenter study. Maturitas. 2007 Aug 20; 57(4): 361-9. https://doi.org/10.1016/j.maturitas.2007.03.004

48. Chaikittisilpa S, Angsuwathana S, Chaovisitsaree S, Jirapinyo M, Wilawan K, Panyakhamlerd K, et al. Clinical responses to the combination of estradiol and drospirenone in symptomatic postmenopausal Thai women. J. Med. Assoc. Thai. 2011, 94, 1019–1025.

Contadores