Therapeutic Effects of Biguanide Vs. Statin in Polycystic Ovary Syndrome: A Randomized Clinical Trial

Abstract

Various classes of medication are currently being used in Polycystic Ovary Syndrome (PCOS) patients including the biguanides and the statins. However, their efficacies are rarely compared. This study aimed to compare efficacy ofa biguanide and a statin in treating PCOS. In a randomized double-blind clinical trial, 400 women with PCOS were recruited within 15 months in Taleghani Hospital. They randomly received either a biguanide (metformin 500 mg three times daily) or a statin (simvastatin 20 mg daily) for three consecutive months. Changes of clinical and laboratory variables were compared. In the biguanide group the serum glucose status (abnormal fasting and non-fasting sugar and insulin levels and percentage of hyperinsulinemic cases) and menstrual abnormalities improved significantly after treatment (p < 0.05). In the statin group the lipid profile status (abnormal total cholesterol, high and low density lipoproteins), C-Reactive Protein (CRP), serum dehydroepiandrosterone sulfate, hyperinsulinemia, severity of acne and menstrual abnormalities improved significantly after treatment (p < 0.05). Comparing the two groups, the improvements in fasting blood sugar and serum insulin levels were significantly better in the biguanide group (p = 0.04 for both parameters); whereas the improvements in serum total cholesterol (p < 0.001), low density lipoprotein (p < 0.001), CRP (p < 0.001) and acne status (p = 0.04) were significantly superior in the statin receivers. Based on these results, each medication is only effective on some aspects of the disease. Overall, the simvastatin was superior to metformin with regard to the number of beneficial effects.

Oral Metformin for Treating Dermatological Diseases: A Systematic Review

“…18,22,23,24 Both Navali et al's and Fruzzetti et al's studies demonstrated that statins (20mg/day simvastatin and 4 g/day myo-inositol, respectively) are superior to 1.5g/ day metformin for treating acne (P<0.05) among other PCOS parameters. 15,25 Combination therapy of metformin 850mg with pioglitazone 7.5mg daily, flutamide 62.5mg daily for 6 months, or oral metformin 850mg twice a day and simvastatin 20mg daily also demonstrated clinical efficacy for improvement in acne…”

“…Women with a history of PCOS with acne, and one study involving men with refractory acne, (total n=1,587 patients) were treated with oral metformin (dose range, 1,000-2,550mg/day). All except three studies [13][14][15] reported significant improvement in acne in female patients with PCOS. Only Fabbrocini et al's study assessed the effects of metformin and a low glycemic diet on male subjects with resistant acne.…”

“…50,51 No statistically significant difference in hirsutism reduction was achieved when comparing metformin monotherapy and N-acetyl cysteine (NAC 600mg three times daily for 24 weeks), myo-inositol (4,000mg daily for 6 months), and simvastatin (20mg daily for 3 months). 15,25,52 In three different studies, three different combination therapies of metformin with five sessions of intense pulsed light therapy (IPL) for 6 months, simvastatin 20mg daily for 6 months and calcium 1,000 mg daily and Vitamin D 50,000 IU for 4 months supplementations improved hirsutism and qualitative patient satisfaction. 26,27,41,[53][54][55]…”

Impact of pharmacological interventions on insulin resistance in women with polycystic ovary syndrome: A systematic review and meta‐analysis of randomized controlled trials

“…Two (3.4%) RCTs compared saxagliptin with metformin 33,74 . Two (3.4%) RCTs compared simvastatin with metformin 55,60 . Two (3.4%) RCTs assessed metformin with NAC 41,61 .…”

Perbandingan Bupivakain Infiltrasi Subkutis dengan Kombinasi Bupivakain Intramuskular Rectus Abdominis dan Subkutis terhadap Mulai Pemberian dan Kebutuhan Analgetik Rescue Pascaoperasi Laparatomi Ginekologi

“…7 Penelitian terhadap pasien yang menjalani operasi seksio sesarea dengan teknik regional anestesia yang mendapatkan infiltrasi 20 mL lidokain 1% dengan 1:100.000 adrenalin menunjukkan bahwa tempat infiltrasi pada luka operasi, yaitu subkutis, intramuskular, dan subkutis ditambah intramuskular secara signifikan dan efektif dapat mengurangi nyeri dan kebutuhan analgetik rescue bila dibanding dengan plasebo. 8 Hasil penelitian lain menunjukkan bahwa infiltrasi selektif terhadap otot rektus pada luka operasi tanpa jaringan fasia dan subkutis di sekitarnya dengan 0,5% bupivakain signifikan mengurangi nilai nyeri serta kebutuhan morfin per jam selama 2 jam pascaoperasi dan total kebutuhan morfin 6 jam pascaoperasi pada histerektomi per abdominal.…”