Comparative efficacy of nonhormonal drugs on menopausal hot flashes

Eur J Clin Pharmacol. 2016 Sep;72(9):1051-8. doi: 10.1007/s00228-016-2090-5. Epub 2016 Jul 24.

Abstract

Purpose: The effects of nonhormonal drugs on menopausal hot flashes are still not well quantified. We therefore did a model-based meta-analysis (MBMA) to quantitate and compare the efficacy features of nonhormonal drugs on menopausal hot flashes.

Methods: Literature was searched in the public databases to extract data of clinical trials on nonhormonal drugs, including selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), gabapentin, clonidine, and soy isoflavones. Pharmacodynamic models were used for the quantitative analysis of each drug.

Results: Thirty-nine studies were included in the analysis. The results revealed a classic pharmacodynamic maximal effect (Emax) model could describe the time course of hot-flash reduction by nonhormonal drugs. After deducting placebo effects, the Emax of SSRIs/SNRIs, gabapentin, clonidine, and soy isoflavones was 13.9 %, 14.8 %, 18.5 %, and 25.0 %, respectively. The time to achieve half of the maximal effect (ET50) of SSRIs/SNRIs, gabapentin, clonidine, and soy isoflavones was 0.18 weeks, 0 weeks, 0 weeks, and 11.6 weeks, respectively. The results showed that SSRIs/SNRIs, gabapentin, and clonidine had a rapid onset, which could reach the maximum effect immediately. However, the onset of soy isoflavones was very slow, and a duration of 16.6 weeks was needed to surpass the efficacy of paroxetine (a type of SSRIs).

Conclusions: The information provided in this study can be used as valuable supplementary information for treatment guidelines of nonhormonal drugs on menopausal hot flashes.

Keywords: Hot flashes; Menopause; Model-based meta-analysis; Nonhormonal agents.

Publication types

  • Meta-Analysis

MeSH terms

  • Amines / therapeutic use
  • Clonidine / therapeutic use
  • Cyclohexanecarboxylic Acids / therapeutic use
  • Female
  • Gabapentin
  • Hot Flashes / drug therapy*
  • Humans
  • Isoflavones / therapeutic use
  • Menopause
  • Models, Biological*
  • Randomized Controlled Trials as Topic
  • Serotonin Uptake Inhibitors / therapeutic use
  • Serotonin and Noradrenaline Reuptake Inhibitors / therapeutic use
  • gamma-Aminobutyric Acid / therapeutic use

Substances

  • Amines
  • Cyclohexanecarboxylic Acids
  • Isoflavones
  • Serotonin Uptake Inhibitors
  • Serotonin and Noradrenaline Reuptake Inhibitors
  • gamma-Aminobutyric Acid
  • Gabapentin
  • Clonidine