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aromatase inhibitorsFrom: mjutras@gate.netFri Feb 13 09:07:45 2004
Are they safe? When you consider the brief period of administration, there are few drugs which would not be safe. Women with breast cancer have taken these drugs daily for years already. Are they effective? That answer is clearly answered in the affirmative. Are they superior to clomiphene? That is the current question. The pilot studies from Casper and his group suggest that they are superior in some groups. To generalized on limited data, they do not seem to be more effective in ovulatory disorder though some women who fail to ovulate with clomiphene will ovulate with letrozole and vice a versa. They appear to be superior in unexplained infertility (were clomiphene alone is not effective) and when doing IUI for male factor. They also appear to be superior in combination with gonadotrophins. They are again superior if you have detected an endometrial problem but as you increase the dose to 2 or 3 pills a day you begin seeing problems with the aromatase inhibitors too. However, though not yet reported, it should be easy to fix that problem since you are not permanently blocking estrogen receptors like you are with clomiphene and tamoxiphene Another safety consideration, if you use letrozole 2.5mg or anastrozole 1 mg, day 3 to 7, the drugs are cleared by the time of implantation. Half life of both drugs are about 48 hours. Clomiphene and its metabolites will be there for the first few weeks of pregnancy. Serono currently has anastrozole in clinical trial in the US. They are looking at using up to 30 mg as a single dose. The point here is that most studies have looked at administration day 3 through 7 though we currently don't know if there is a superior way especially in resistant patients. Mark Jutras, MD Orlando
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