***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Objective : To investigate the effect of a combiphasic oral contraceptive containing ethinylestradiol and desogestrel ( combiphasic EE/DSG ) on  acne  , compared with a preparation containing ethinylestradiol and cyproterone acetate ( EE35/CPA ) . Methods : An open , r and omized , group-comparative , multicenter study was carried out , with 172 women r and omized to treatment with either combiphasic EE/DSG ( 25 μg desogestrel and 40 μg ethinylestradiol for 7 days followed by 125 μg desogestrel and 30 μg ethinylestradiol for 15 days ) or EE35/CPA ( 2.0 mg cyproterone acetate and 35 μg ethinylestradiol for 21 days ) . Assessment s were performed at pretreatment and after cycles 3 and 6 . Results : The number of comedones , papules , pustules and nodules significantly decreased in both groups over the 6-month study . Compared with pretreatment (= 100 % ) , the relative numbers of comedones , papules , pustules and nodules at cycle 6 significantly decreased to 37 % , 38 % , 19 % and 12.5 % in the combiphasic EE/DSG group and to 24 % , 36 % , 17 % and 1 % in the EE35/CPA group , respectively . All reductions were statistically significant ( p ≤ 0.003 ) at both cycles 3 and 6 , except for nodules at cycle 6 with combiphasic EE/DSG , which probably result ed from differences between the treatment groups at baseline . There were no statistically significant differences between the two treatments . In both groups , the majority of women with severe acne shifted to a less severe acne category . Conclusions : Combiphasic EE/DSG progressively reduced the number and severity of acne lesions during the six cycles of treatment . The reduction in acne with the combiphasic oral contraceptive was comparable to a preparation containing the anti and rogen cyproterone acetate Abstract ▴ Ethinylestradiol/chlormadinone acetate 0.03/2 mg ( EE/CMA ) is a combined monophasic contraceptive pill with anti and rogenic properties . ▴ In a large , noncomparative , multicentre trial ( ≤24 cycles of treatment per woman ) and two ( 6- and 12-cycle ) postmarketing surveillance studies , EE/ CMA was effective in preventing pregnancy . ▴ EE/CMA was significantly more effective than EE/ levonorgestrel 0.03/0.15 mg/day in treating women with mild-to-moderate papulopustular acne of the face and related disorders in a r and omised , single-blind , multicentre trial . ▴ EE/CMA was well tolerated in clinical trials and the postmarketing surveillance studies . Adverse events were those commonly reported with oral contraceptives . As expected , the most common menstrual disturbances were breakthrough bleeding , spotting and amenorrhoea To study the question of whether one br and of oral contraceptives may be as acceptable as another for use of publicly-assisted family planning programs , a double blind study of two well-known br and s , Ovral and Norinyl  , was undertaken in Costa Rica and Trinidad . The pills were r and omly assigned to 1,200 women . Common side effects - nausea , dizziness , vomiting , headaches - were associated with both Norinyl and Ovral . Differences in event rates for these conditions were much more marked by country than by the pill used . Ovral was associated with increases in skin problems , notably chloasma , in Cost Rica . A higher percentage of women using Norinyl reported intermenstrual bleeding and spotting in both countries . In Costa Rica continuation rates for Norinyl were adversely affected by this . With these exceptions there appear to be no important differences between the br and s that would affect their use in family planning programs OBJECTIVE To investigate the effects of an ethinylestradiol ( EE ) 20 μg/drospirenone ( drsp ) 3 mg combined oral contraceptive ( COC ) administered in a 24/4 regimen ( 24 active tablets/4 inert tablets per cycle ) for the treatment of moderate acne vulgaris , based on a pooled analysis of two identically design ed US studies . STUDY DESIGN Healthy females ( n=893 ) aged 14 - 45 years with moderate facial acne were r and omised to EE 20 μg/drsp 3 mg COC ( n=451 ) or placebo ( n=442 ) for six cycles . Primary outcome measures were mean percent change in acne lesion counts and the investigators ' assessment of acne from baseline to endpoint . RESULTS There were significantly greater reductions in the mean percent change from baseline to endpoint in inflammatory , non-inflammatory and total lesion counts in the EE 20 μg/drsp 3 mg 24/4 COC group compared with the placebo group ( P<0.0001 ) . The odds of women in the EE 20 μg/drsp 3 mg 24/4 COC group having ' clear ' or ' almost clear ' skin as rated by the investigators at endpoint were around three-fold greater than in the placebo group ( odds ratio 3.41 ; 95 % CI : 2.15 - 5.43 ; P<0.0001 ) . CONCLUSIONS A low-dose COC containing EE 20 μg/drsp 3 mg ( 24/4 ) more effectively reduced acne lesions  than placebo and demonstrated greater improvement in the investigator global assessment of acne OBJECTIVE To compare the effects of a low-dose oral contraceptive containing desogestrel ( Marvelon ) and an anti- and rogenic preparation containing cyproterone acetate ( Diane ) in Oriental women suffering from acne . METHODS In an open-label , bi-center , r and omized study , 32 women using Marvelon and 34 using Diane  were followed for 6 treatment cycles . The measured variables were objective and subjective severity of acne , and related biochemical variables such as sex hormone-binding globulin and free and total testosterone . RESULTS In Center A , with both preparations a decrease in mean objective acne score was observed , reaching statistical significance with Diane ( P < .05 ) . In addition , there was a significant between group difference at cycle 6 ( P < .05 ) . In Center B , a consistent and significant decrease in mean acne score was observed with Marvelon after three and six treatment cycles ( P < .05 and P < .01 ) and with Diane after six treatment cycles ( P < .001 ) . There were no significant between-group differences . The decrease in percentage of severe/moderate acne was statistically significant with Marvelon in Center B ( P = 0.002 ) and with Diane in Centers A ( P = 0.014 ) and B ( P = 0.004 ) . Both preparations increased plasma levels of sex hormone binding globulin and seemed to decrease those of total and free testosterone , but no statistically significant relationships between acne severity and biochemical variables could be detected . CONCLUSION Both Marvelon and Diane are effective in the treatment of acne in Oriental women who also need reliable contraception , without marked differences between the preparations A multicenter r and omized study was carried out to compare the efficacy of combined therapy with a GnRH analog ( goserelin ) + an oral contraceptive ( OC ) containing ethinyl estradiol and cyproterone acetate and same OC alone in the treatment of severe hirsutism . The effect of these two therapies was assessed in a subjective and an objective evaluation of hair growth . According to the subjective evaluation , judged by physician and patient . 95 % of patients obtained a partial response . The objective response was assessed by measuring the mean diameter of hair from 3 different areas and 1 control area . The decrease in hair diameter compared to pretreatment was statistically significant for both treatments , mainly for the abdomen and face . The difference between the two groups did not reach statistical significance . Therefore , we assume that OC alone remains the treatment of choice for hirsutism . However , the addition of the GnRH analog to OC needs further investigation and could be justified for patients with no response to st and ard monotherapy BACKGROUND An excess of and rogen is believed to contribute to development of acne in some patients . Because oral contraceptives ( OCs ) may reduce the active and rogen level , hormonal therapy with OCs has been used successfully to treat patients with acne , although this treatment has previously not been studied in placebo-controlled trials . OBJECTIVE Our purpose was to evaluate the efficacy of a triphasic , combination OC ( ORTHO TRI-CYCLEN [ Ortho-McNeil Pharmaceutical , Raritan , N.J. ] , norgestimate/ethinyl estradiol ) compared with placebo in the treatment of moderate acne vulgaris . METHODS Two hundred fifty-seven healthy female subjects , 15 to 49 years of age with moderate acne vulgaris , were enrolled in a multicenter , r and omized , double-blind , placebo-controlled clinical trial . Each month for 6 months , subjects received either 3 consecutive weeks of the OC ( i.e. , tablets containing a fixed dose of ethinyl estradiol [ 0.035 mg ] and increasing doses of norgestimate [ 0.180 mg , 0.215 mg , 0.250 mg ] ) followed by 7 days of inactive drug or placebo ( color-matched tablets ) . Efficacy was assessed by facial acne lesion counts , an investigator 's global assessment , a subject 's self- assessment , and an analysis of within-cycle variation ( cycle 6 ) in lesion counts . RESULTS Of the 160 subjects in whom efficacy could be evaluated , the OC group showed a statistically significantly greater improvement than the placebo group for all primary efficacy measures . The mean decrease in inflammatory lesion count from baseline to cycle 6 was 11.8 ( 62.0 % ) versus 7.6 ( 38.6 % ) ( p = 0.0001 ) , and the mean decrease in total lesion count was 29.1 ( 53.1 % ) versus 14.1 ( 26.8 % ) ( p = 0.0001 ) in the OC and placebo groups , respectively . In the investigator 's global assessment , 93.7 % of the active treatment group versus 65.4 % of the placebo group were rated as improved at the end of the study ( p < 0.001 ) . Six of the seven secondary efficacy measures ( total comedones , open comedones , closed comedones , papules , pustules , and the subject 's self- assessment of study treatment ) were also significantly more favorable in the OC group compared with the placebo group . CONCLUSION An OC containing 0.035 mg of ethinyl estradiol combined with the triphasic regimen of norgestimate is a safe and effective treatment of moderate acne vulgaris in women with no known contraindication to OC therapy The early days of oral contraceptives showed some evidence that these medications may have caused undesirable side effects on the voice , mainly in terms of virilization . In a r and om study carried out at the university hospitals of Jena and Berlin ( Charité ) , two more recent drugs were tested in this regard , one containing cyproterone acetate ( Diane-35 ) and the other one levonorgestrel ( Microgynon ) , both from Schering . Ninety-one patients took part in extensive clinical and instrumental phoniatric investigations of voice function over a period of one year . No significant side effects on the voice could be proven for the two preparations . Gynecological and clinical effects of both Diane-35 and Microgynon were similar during the one-year study period . Women taking Diane-35 had less intracyclic bleedings and amenorrhea . Also , acne was more favorably influenced by Diane-35 The aim for improving the progestogen component of oral contraceptives is both to increase their selectivity by obtaining a highly effective contraceptive action and to decrease the side effects related to the existing progestogens . The and rogenic activity of the existing progestogens modifies the lipid metabolism , particularly a decrease in the high density lipoprotein ( HDL ) level , which increases the risks of cardiovascular diseases . Thus , the discovery of a progestogen with good anti-ovulatory and minimal and rogenic properties would constitute an important progress in the field of oral contraception . Norgestimate ( NGM ) is a new progestogen presenting an exceptional profile of biological activity , and has proved to be extremely selective , as observed during the clinical trials . The studies described below have been carried out in order to confirm clinical ly the low and rogenic activity of NGM . In two clinical trials , Norgestimate ( 0.25 mg ) associated with 0.035 mg of ethinyloestradiol ( NGM 0.25/35 ) was compared to norgestrel ( 0.30 mg ) associated with 0.030 mg of ethinyloestradiol ( Lo/Ovral ) . In the first trial ( 1,261 women ) , the following observations were made : an important increase in the HDL level compared to the base levels in the subjects taking NGM 0.25/35 , and an important decrease in the HDL level in those taking Lo/Ovral . The low density lipoprotein ( LDL ) level increased slightly in the NGM 0.25/35 group , while a higher increase was observed in the Lo/Ovral group . Moreover 
    Output:
    
A CMA-COC group had more ' responders , ' those with 50 % or greater decrease in facial papules and pustules ( OR 2.31 ; 95 % CI 1.50 to 3.55)Differences in the comparative effectiveness of COCs containing varying progestin types and dosages were less clear , and data were limited for any particular comparison .
COCs that contained chlormadinone acetate or cyproterone acetate improved acne better than levonorgestrel .
Likewise , levonorgestrel showed a slight improvement over desogestrel in acne outcomes , but results were not consistent .
A drospirenone COC appeared to be more effective than norgestimate or nomegestrol acetate plus 17β-estradiol but less effective than cyproterone acetate .
The six COCs evaluated in placebo-controlled trials are effective in reducing inflammatory and non-inflammatory facial acne lesions .
Few important and consistent differences were found between COC types in their effectiveness for treating acne .