Effects of different insulin sensitisers in the management of polycystic ovary syndrome: A systematic review and meta‐analysis

• Published in: Clinical endocrinology (Oxford) Vol. 100; no. 2; pp. 149 - 163
• Main Authors: 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.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.02.2024
• Subjects: Adult; BMI; Body mass index; Clinical trials; combination; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Endocrinology & Metabolism; Endocrinology and Diabetes; Endokrinologi och diabetes; endothelial function; Female; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Insulin Resistance; Meta-analysis; Metabolism; Metformin; Metformin - therapeutic use; obesity; Ovaries; Pioglitazone; Pioglitazone - therapeutic use; polycystic ovary; Polycystic ovary syndrome; Polycystic Ovary Syndrome - drug therapy; resistance; Rosiglitazone; Rosiglitazone - therapeutic use; rosiglitazone treatment; syndrome; syndrome pcos; Systematic review; Testosterone; therapy; Thiazolidinediones; Thiazolidinediones - therapeutic use; women; thiazolidinediones; pioglitazone; metformin; rosiglitazone; insulin resistance; BMI; polycystic ovary syndrome
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/cen.14983

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.