Effects of different insulin sensitisers in the management of polycystic ovary syndrome: A systematic review and meta‐analysis
Melin, Johanna M.; Forslund, Maria; Alesi, Simon J.; Piltonen, Terhi; Romualdi, Daniela; Spritzer, Poli M.; Tay, Chau Thien; Pena, Alexia S.; Witchel, Selma F.; Mousa, Aya; Teede, Helena J. (2023-11-07)
John Wiley & Sons
07.11.2023
Melin JM, Forslund M, Alesi SJ, et al. Effects of different insulin sensitisers in the management of polycystic ovary syndrome: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2024; 100: 149-163. doi:10.1111/cen.14983
https://rightsstatements.org/vocab/InC/1.0/
© 2023 John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Melin JM, Forslund M, Alesi SJ, et al. Effects of different insulin sensitisers in the management of polycystic ovary syndrome: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2024; 100: 149-163 which has been published in final form at https://doi.org/10.1111/cen.14983. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
https://rightsstatements.org/vocab/InC/1.0/
© 2023 John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Melin JM, Forslund M, Alesi SJ, et al. Effects of different insulin sensitisers in the management of polycystic ovary syndrome: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2024; 100: 149-163 which has been published in final form at https://doi.org/10.1111/cen.14983. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
https://rightsstatements.org/vocab/InC/1.0/
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:oulu-202312183886
https://urn.fi/URN:NBN:fi:oulu-202312183886
Tiivistelmä
Abstract
Objective:
Characteristic features of polycystic ovary syndrome (PCOS) include insulin resistance and an increased risk for type 2 diabetes. To promote improved insulin sensitivity, insulin sensitisers have been used in PCOS. However, direct comparisons across these agents are limited. This study compared the effects of metformin, rosiglitazone and pioglitazone in the management of PCOS to inform the 2023 International Evidence-based PCOS Guideline.
Design:
Systematic review and meta-analysis of the literature.
Patients:
Women with PCOS and treatment with insulin sensitisers.
Measurements:
Hormonal and clinical outcomes, as well as side effects.
Results:
Of 1660 publications identified, 13 randomised controlled trials were included. Metformin was superior in lowering weight (mean difference [MD]: −4.39, 95% confidence interval [CI]: −7.69 to −1.08 kg), body mass index (MD: −0.95, 95% CI: −1.41 to −0.49 kg/m2) and testosterone (MD: −0.10, 95% CI: −0.18 to −0.03 nmol/L) versus rosiglitazone, whereas there was no difference when comparing metformin to pioglitazone. Adding rosiglitazone or pioglitazone to metformin did not improve metabolic outcomes. However, rosiglitazone seemed superior to metformin in lowering lipid concentrations.
Conclusions:
Metformin should remain the first-line insulin sensitising treatment in adults with PCOS for the prevention and management of weight and metabolic features. The addition of thiazolidinediones appears to offer little benefit.
Objective:
Characteristic features of polycystic ovary syndrome (PCOS) include insulin resistance and an increased risk for type 2 diabetes. To promote improved insulin sensitivity, insulin sensitisers have been used in PCOS. However, direct comparisons across these agents are limited. This study compared the effects of metformin, rosiglitazone and pioglitazone in the management of PCOS to inform the 2023 International Evidence-based PCOS Guideline.
Design:
Systematic review and meta-analysis of the literature.
Patients:
Women with PCOS and treatment with insulin sensitisers.
Measurements:
Hormonal and clinical outcomes, as well as side effects.
Results:
Of 1660 publications identified, 13 randomised controlled trials were included. Metformin was superior in lowering weight (mean difference [MD]: −4.39, 95% confidence interval [CI]: −7.69 to −1.08 kg), body mass index (MD: −0.95, 95% CI: −1.41 to −0.49 kg/m2) and testosterone (MD: −0.10, 95% CI: −0.18 to −0.03 nmol/L) versus rosiglitazone, whereas there was no difference when comparing metformin to pioglitazone. Adding rosiglitazone or pioglitazone to metformin did not improve metabolic outcomes. However, rosiglitazone seemed superior to metformin in lowering lipid concentrations.
Conclusions:
Metformin should remain the first-line insulin sensitising treatment in adults with PCOS for the prevention and management of weight and metabolic features. The addition of thiazolidinediones appears to offer little benefit.
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