Utilidad de leuprolide en comparación con implantes de histrelina en el tratamiento de la pubertad precoz central: Revisión sistemática

Abstract

Introduction: Central precocious puberty (CPP) is an early activation of the hypothalamic-pituitary-gonadal axis, manifesting before the age of 8 years in girls and 9 years in boys. It is classified as idiopathic or organic, and treatment is based on GnRH analogues such as leuprolide and histrelin implants, whose effectiveness and safety profile are compared in this review. Objective: To evaluate the clinical efficacy of leuprolide versus histrelin implants in the treatment of CPP, considering adherence, tolerability, and adverse events. Methodology: Articles and comparative studies in English or Spanish published within the last 5 years, which were performed on humans over 18 years of age, were selected. Cases, reviews, and studies lacking methodological rigor were excluded. The sources of information were PubMed and Taylor & Francis. The risk of bias was evaluated using the RoB 2 (clinical trials) and JBI (observational) tools. The results, including adverse events and adherence, were tabulated, along with a narrative on efficacy. Results: Nineteen studies were included: 2 clinical trials, 5 cross-sectional, and 12 cohort studies. Both treatments showed effective suppression of the gonadotropic axis. Histrelin showed a longer duration of action and fewer adverse effects. Leuprolide showed good adherence, although it requires frequent administration. Discussion: Limitations include the risk of bias in some studies and heterogeneity in populations and therapeutic regimens; however, both treatments demonstrated high efficacy and safety. Conclusions: Both leuprolide and histrelin are valid options for CPP; the choice should be based on the patient's profile, access, and family preferences.