Pharmacokinetics, metabolism and serum concentrations of progestins used in contraception.

Pharmacokinetics, metabolism and serum concentrations of progestins used in contraception.
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避孕用孕激素的药代动力学、代谢和血药浓度。

DOI:
10.1016/j.pharmthera.2020.107789
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发表时间:
2021-06
影响因子:
13.5
通讯作者:
Hapgood JP
Hapgood JP
中科院分区:
医学1区
文献类型:
--
作者:
Bick AJ;Louw-du Toit R;Skosana SB;Africander D;Hapgood JP

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全世界数以百万计的妇女使用许多不同形式的激素避孕。这些避孕药具在使用的合成孕激素化合物(黄体酮)的剂量和类型、给药途径以及是否含有雌激素化合物方面各不相同。人们越来越认识到,不同形式的避孕和不同的孕激素具有不同的副作用,特别是它们对心血管的影响、对生殖癌症的影响和对传染病的易感性。有必要发展新的方法,以适应不同的需要,并以最小的风险,特别是在资源不足的地区。这需要更好地了解用于避孕的孕激素的药代动力学、代谢、血清和组织浓度,以及孕激素及其代谢物通过类固醇受体的生物活性。在这里,我们回顾了目前关于这些主题的知识,并确定了研究差距。我们表明,对大多数孕激素的大多数这些主题的研究都很缺乏。我们发现,在这些主题上明确结论的主要障碍包括缺乏标准化的方法,非平行临床研究之间的比较以及研究之间和研究内部血清浓度数据的可变性。后者很可能是由于,至少部分是由于参与者内在特征的差异。该审查强调了深入了解这些主题的重要性,以便以最小的风险向妇女提供最佳避孕选择。
Many different forms of hormonal contraception are used by millions of women worldwide. These contraceptives differ in the dose and type of synthetic progestogenic compound (progestin) used, as well as the route of administration and whether or not they contain estrogenic compounds. There is an increasing awareness that different forms of contraception and different progestins have different side-effect profiles, in particular their cardiovascular effects, effects on reproductive cancers and susceptibility to infectious diseases. There is a need to develop new methods to suit different needs and with minimal risks, especially in under-resourced areas. This requires a better understanding of the pharmacokinetics, metabolism, serum and tissue concentrations of progestins used in contraception as well as the biological activities of progestins and their metabolites via steroid receptors. Here we review the current knowledge on these topics and identify the research gaps. We show that there is a paucity of research on most of these topics for most progestins. We find that major impediments to clear conclusions on these topics include a lack of standardized methodologies, comparisons between non-parallel clinical studies and variability of data on serum concentrations between and within studies. The latter is most likely due, at least in part, to differences in intrinsic characteristics of participants. The review highlights the importance of insight on these topics in order to provide the best contraceptive options to women with minimal risks.
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