Discontinuous low-dose flutamide-metformin plus an oral or a transdermal contraceptive in patients with hyperinsulinaemic hyperandrogenism: normalizing effects on CRP, TNF-alpha and the neutrophil/lymphocyte ratio.

Abstract

BACKGROUND:

Low-dose flutamide-metformin (Flu-Met) with an oral contraceptive is a therapeutic option for women with hyperinsulinaemic hyperandrogenism. We questioned (i) whether Flu-Met maintains efficacy if given discontinuously; (ii) how the efficacy of discontinuous Flu-Met plus a transdermal contraceptive compares with Flu-Met plus oral contraceptive; and (iii) whether these treatments also lower circulating C-reactive protein (CRP) and tumour necrosis factor alpha (TNF-alpha) and the high neutrophil/lymphocyte ratio.

METHODS:

Non-obese, young patients (n = 31) with hyperinsulinaemic hyperandrogenism were started on Flu-Met (21/28 days) and randomized to receive in addition either a drospirenone oral contraceptive or a transdermal contraceptive for 6 months.

RESULTS:

The effects of Flu-Met were similar whether combined with oral or transdermal contraceptive. In both groups, CRP and TNF-alpha levels fell and the high neutrophil/lymphocyte ratio normalized (P < 0.001). Lean body mass increased (P < 0.001) in both groups but, in contrast to earlier experience with continuous Flu-Met, fat mass failed to decrease in either group.

CONCLUSIONS:

Flu-Met seems less lipolytic, if given for only 21 days in every 28-day period. The efficacy of Flu-Met is comparable when combined with an oral contraceptive or a transdermal contraceptive. The range of Flu-Met effects may henceforth include lower levels of CRP and TNF-alpha, and a normalization of the neutrophil/lymphocyte ratio.

• Authors: Lourdes Ibáñez, Carme Valls, Francis de Zegher
• Journal: Human reproduction (Oxford, England) (Hum Reprod) Vol. 21 Issue 2 Pg. 451-6 (Feb 2006) ISSN: 0268-1161 [Print] England
• PMID: 16239318 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Contraceptive Agents, Female
• Contraceptives, Oral
• Tumor Necrosis Factor-alpha
• Flutamide
• C-Reactive Protein
• Metformin

Topics

• Administration, Cutaneous
• Adolescent
• Adult
• C-Reactive Protein (analysis)
• Contraceptive Agents, Female (administration & dosage, therapeutic use)
• Contraceptives, Oral (administration & dosage, therapeutic use)
• Drug Therapy, Combination
• Female
• Flutamide (administration & dosage, therapeutic use)
• Humans
• Hyperandrogenism (blood, drug therapy)
• Hyperinsulinism (blood, drug therapy)
• Leukocyte Count
• Lymphocytes (drug effects)
• Metformin (administration & dosage, therapeutic use)
• Neutrophils (drug effects)
• Tumor Necrosis Factor-alpha (analysis)