Metformin vs thiazolidinediones for treatment of clinical, hormonal and metabolic characteristics of polycystic ovary syndrome: a meta-analysis

Xj, Li; Yx, Yu; Cq, Liu; Zhang, W; Hj, Zhang; Yan, Bo; Ly, Wang; Sy, Yang; Sh, Zhang

doi:10.1111/j.1365-2265.2010.03917.x

Cited by 56 publications

(51 citation statements)

References 58 publications

(154 reference statements)

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“…Pioglitazone and rosiglitazone, the two currently available TZDs, have been shown to be effective in improving some metabolic (insulin resistance and IGT), hormonal (hyperandrogenaemia) as well as reproductive parameters (ovulation rate and menstrual cyclicity) of PCOS (222,223). At present there is not sufficient evidence to support the suggestion that TZDs are superior to metformin in metabolic and reproductive aspects of PCOS (222). Most importantly, TZDs may increase body weight due to fluid retention, which is a major concern in women with PCOS having a high prevalence of obesity (224).…”

Section: Subclinical CV Disease In Pcosmentioning

confidence: 99%

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

Conway¹,

Dewailly²,

Diamanti-Kandarakis³

et al. 2014

European Journal of Endocrinology

569

492

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Polycystic ovary syndrome (PCOS) is the most common ovarian disorder associated with androgen excess in women, which justifies the growing interest of endocrinologists. Great efforts have been made in the last 2 decades to define the syndrome. The presence of three different definitions for the diagnosis of PCOS reflects the phenotypic heterogeneity of the syndrome. Major criteria are required for the diagnosis, which in turn identifies different phenotypes according to the combination of different criteria. In addition, the relevant impact of metabolic issues, specifically insulin resistance and obesity, on the pathogenesis of PCOS, and the susceptibility to develop earlier than expected glucose intolerance states, including type 2 diabetes, has supported the notion that these aspects should be considered when defining the PCOS phenotype and planning potential therapeutic strategies in an affected subject. This paper offers a critical endocrine and European perspective on the debate on the definition of PCOS and summarises all major aspects related to aetiological factors, including early life events, potentially involved in the development of the disorder. Diagnostic tools of PCOS are also discussed, with emphasis on the laboratory evaluation of androgens and other potential biomarkers of ovarian and metabolic dysfunctions. We have also paid specific attention to the role of obesity, sleep disorders and neuropsychological aspects of PCOS and on the relevant pathogenetic aspects of cardiovascular risk factors. In addition, we have discussed how to target treatment choices based according to the phenotype and individual patient's needs. Finally, we have suggested potential areas of translational and clinical research for the future with specific emphasis on hormonal and metabolic aspects of PCOS.

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Section: Subclinical CV Disease In Pcosmentioning

confidence: 99%

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

Conway¹,

Dewailly²,

Diamanti-Kandarakis³

et al. 2014

European Journal of Endocrinology

569

492

View full text Add to dashboard Cite

show abstract

“…72 Among the available options, pioglitazone appears to improve insulin sensitivity to a similar degree as metformin, both agents exerting a synergistic effect on IR in patients with PCOS. 73,77 However, safety concerns, including the risk of weight gain and edema, limit the use of pioglitazone in this population. 54 Limited data also suggest that glucagon-like peptide 1 analogues combined with metformin attenuate IR and reduce weight more effectively than metformin monotherapy.…”

mentioning

confidence: 99%

Prevalence, pathogenesis and management of prediabetes and type 2 diabetes mellitus in patients with polycystic ovary syndrome

Lazaridou

Dinas

Τζιόμαλος

2018

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Polycystic ovary syndrome (PCos) is the most common endocrinopathy in women of reproductive age. PCos is not only the leading cause of anovulatory infertility but is also associated with an array of metabolic disorders, among which impaired glucose metabolism has been a topic of intense research. The aim of the present narrative review is to summarize the findings of the studies that have evaluated the prevalence and incidence of prediabetes and type 2 diabetes mellitus (T2Dm) in patients with PCos, to analyze the factors underpinning the association between T2Dm and PCos and to discuss the current strategies for screening and management of impaired glucose metabolism in this population. Both prediabetes and T2Dm are highly prevalent in patients with PCos. Accordingly, regular screening is recommended in this population for the early identification of impaired glucose metabolism, particularly in overweight or obese patients and in those with a family history of T2Dm. Prevention of T2Dm in patients with prediabetes is primarily based on lifestyle changes, while metformin might be considered in selected cases. The treatment of T2Dm is similar in patients with and without PCos but appropriate contraceptive measures should be implemented in patients receiving treatments other than insulin, metformin or glyburide.

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“…38 The studies included in this meta-analysis that evaluated lipid control were of limited duration (3 months [n = 6] to 6 months [n = 4]) and included patients with BMIs of 29-34 kg/m 2 . In addition, it did not assess medication history, which may have had a bearing on changes in lipid levels.…”

Section: Association Between Pcos and Cvdmentioning

confidence: 99%

Polycystic Ovarian Syndrome: Metformin or Thiazolidinediones for Cardiovascular Risk Reduction?

Janci¹,

Smith²,

Odegard³

2012

Diabetes Spectrum

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Objective. The purpose of this article is to explore the relationships among polycystic ovarian syndrome (PCOS), diabetes, and cardiovascular (CV) risk and review the use of metformin and thiazolidinediones (TZDs) in reducing CV risk in women with PCOS. Methods. The authors conducted a search for and reviewed reports of clinical trials, meta-analyses, and controlled trials published from January 1998 to December 2012 included in the PubMed, Cochrane Collaborative, and Health and Psychosocial Instruments databases. Search terms included PCOS, polycystic ovary/ovarian syndrome, diabetes mellitus, hyperglycemia, cardiovascular, metformin, TZDs, thiazolidinediones, rosiglitazone, and pioglitazone. Results. The articles provided evidence that PCOS is associated with both metabolic syndrome and diabetes in women. Metformin is an effective treatment for diabetes with favorable effects on lipid abnormalities to reduce CV risk. TZDs demonstrate some benefit on clinical markers associated with PCOS. However, there is no evidence that TZDs provide a greater benefit than metformin in reducing CV risk in women with PCOS and diabetes. Additionally, there is concern that TZDs may increase patients' risk of adverse events. Conclusions. Based on evidence linking PCOS to diabetes and increased CV risks, clinicians should systematically screen women with diabetes for PCOS and direct appropriate treatment at minimizing related risks. Treatment with metformin appears to be more beneficial than TZDs and has been shown to lower triglycerides, increase HDL cholesterol, and favorably influence serum insulin levels.

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Metformin vs thiazolidinediones for treatment of clinical, hormonal and metabolic characteristics of polycystic ovary syndrome: a meta-analysis

Abstract: The findings from this meta-analysis do not indicate that metformin is superior to TZD's for the treatment of PCOS or vice versa. Between studies, heterogeneity was a major confounder. A large scale, well-designed, randomized, controlled trial is needed to further address this issue.

Cited by 56 publications

References 58 publications

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

Prevalence, pathogenesis and management of prediabetes and type 2 diabetes mellitus in patients with polycystic ovary syndrome

Polycystic Ovarian Syndrome: Metformin or Thiazolidinediones for Cardiovascular Risk Reduction?

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