A Novel Letrozole Stair-Step Duration Regimen for Ovulation Induction in Women with Polycystic Ovary Syndrome and Letrozole Resistance.

IF 5.1 2区医学 Q1 CHEMISTRY, MEDICINAL

Drug Design, Development and Therapy Pub Date : 2025-09-29 eCollection Date: 2025-01-01 DOI:10.2147/DDDT.S538102

Xiuxian Zhu, Jingwen Lang, Yunqing Zhi, Qiaoling Wang, Yonglun Fu

{"title":"A Novel Letrozole Stair-Step Duration Regimen for Ovulation Induction in Women with Polycystic Ovary Syndrome and Letrozole Resistance.","authors":"Xiuxian Zhu, Jingwen Lang, Yunqing Zhi, Qiaoling Wang, Yonglun Fu","doi":"10.2147/DDDT.S538102","DOIUrl":null,"url":null,"abstract":"Background: Letrozole is the first-line treatment for ovulation induction in women with polycystic ovary syndrome (PCOS). However, a subset of patients remains anovulatory despite standard treatment, a condition termed \"letrozole resistance\". This retrospective cohort study aimed to evaluate the effectiveness and time efficiency of a novel \"letrozole stair-step duration regimen\", which skips progestin-induced withdrawal bleeding and proceeds directly to an extended letrozole course after anovulatory cycles, compared with a previously established \"2-step extended letrozole regimen\".Methods: We analyzed 158 women with PCOS and letrozole resistance who underwent ovulation induction at two university-affiliated reproductive centers between March 2018 and September 2024. Participants received either the stair-step duration regimen (n = 62) or the 2-step extended regimen (n = 96). Outcomes compared included follicular development, hormone profiles, ovulation, and pregnancy outcomes. The primary outcome was the ovulation rate.Results: Ovulation rates were comparable between groups [95.16% vs 94.79%]. Clinical pregnancy rates [23.73% (14/59) vs 20.88% (19/91), P = 0.681] and live birth rates [16.95% (11/59) vs 18.68% (17/91), P = 0.824] also showed no significant differences. However, the stair-step group achieved ovulation in a significantly shorter time, with a median of 36 days (interquartile range [IQR] 32-54) versus 47 days (IQR 45-51) in the extended regimen group (P < 0.001).Conclusion: The letrozole stair-step duration regimen is a time-saving and effective ovulation induction protocol for women with PCOS and letrozole resistance, yielding comparable reproductive outcomes in a shorter treatment duration.","PeriodicalId":11290,"journal":{"name":"Drug Design, Development and Therapy","volume":"19 ","pages":"8793-8803"},"PeriodicalIF":5.1000,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494071/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Drug Design, Development and Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/DDDT.S538102","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"CHEMISTRY, MEDICINAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Letrozole is the first-line treatment for ovulation induction in women with polycystic ovary syndrome (PCOS). However, a subset of patients remains anovulatory despite standard treatment, a condition termed "letrozole resistance". This retrospective cohort study aimed to evaluate the effectiveness and time efficiency of a novel "letrozole stair-step duration regimen", which skips progestin-induced withdrawal bleeding and proceeds directly to an extended letrozole course after anovulatory cycles, compared with a previously established "2-step extended letrozole regimen".

Methods: We analyzed 158 women with PCOS and letrozole resistance who underwent ovulation induction at two university-affiliated reproductive centers between March 2018 and September 2024. Participants received either the stair-step duration regimen (n = 62) or the 2-step extended regimen (n = 96). Outcomes compared included follicular development, hormone profiles, ovulation, and pregnancy outcomes. The primary outcome was the ovulation rate.

Results: Ovulation rates were comparable between groups [95.16% vs 94.79%]. Clinical pregnancy rates [23.73% (14/59) vs 20.88% (19/91), P = 0.681] and live birth rates [16.95% (11/59) vs 18.68% (17/91), P = 0.824] also showed no significant differences. However, the stair-step group achieved ovulation in a significantly shorter time, with a median of 36 days (interquartile range [IQR] 32-54) versus 47 days (IQR 45-51) in the extended regimen group (P < 0.001).

Conclusion: The letrozole stair-step duration regimen is a time-saving and effective ovulation induction protocol for women with PCOS and letrozole resistance, yielding comparable reproductive outcomes in a shorter treatment duration.

查看原文本刊更多论文

一种新的来曲唑阶梯疗程治疗多囊卵巢综合征和来曲唑耐药妇女促排卵。

背景：来曲唑是多囊卵巢综合征（PCOS）妇女促排卵的一线治疗药物。然而，尽管进行了标准治疗，仍有一部分患者无排卵，这种情况被称为“来曲唑耐药性”。本回顾性队列研究旨在评估新型“来曲唑阶梯疗程方案”的有效性和时间效率，该方案跳过孕激素诱导的停药性出血，在无排卵周期后直接进行延长来曲唑疗程，而不是之前建立的“2步延长来曲唑方案”。方法：我们分析了2018年3月至2024年9月在两所大学附属生殖中心接受促排卵治疗的158名多囊卵巢综合征和来曲唑抵抗的女性。参与者接受阶梯持续方案（n = 62）或2步延长方案（n = 96）。比较的结果包括卵泡发育、激素谱、排卵和妊娠结局。主要结果是排卵率。结果：两组间排卵率具有可比性[95.16%对94.79%]。临床妊娠率[23.73% (14/59)vs 20.88% (19/91), P = 0.681]和活产率[16.95% (11/59)vs 18.68% (17/91), P = 0.824]差异无统计学意义。然而，阶梯组在明显更短的时间内实现排卵，中位数为36天（四分位数范围[IQR] 32-54），而延长方案组为47天（IQR 45-51）（P < 0.001）。结论：来曲唑阶梯持续方案是一种省时有效的促排卵方案，可在较短的治疗时间内获得相当的生殖效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.