Impact of pharmacological interventions on biochemical hyperandrogenemia in women with polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials.

Abstract

CONTEXT:

Polycystic ovary syndrome (PCOS) is a complex endocrine disease that affects women of reproductive age and is characterised by biochemical and clinical androgen excess.

AIM:

To evaluate the efficacy of pharmacological interventions used to decrease androgen hormones in women with PCOS.

DATA SOURCE:

We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library and the Web of Science from inception up to March 2021.

DATA SYNTHESIS:

Two reviewers selected eligible studies and extracted data, and the review is reported according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

RESULTS:

Of the 814 randomised clinical trials (RCTs) located in the search, 92 met the eligibility criteria. There were significant reductions in total testosterone level with metformin versus (vs) placebo (SMD: - 0.33; 95% CI  - 0.49 to  - 0.17, p < 0.0001, moderate grade evidence) and dexamethasone vs placebo (MD:-0.86 nmol/L; 95% CI  - 1.34 to  - 0.39, p = 0.0004, very low-grade evidence). Significant reductions in the free testosterone with sitagliptin vs placebo (SMD:  - 0.47; 95% CI  - 0.97 to 0.04, p = 0.07, very low-grade evidence), in dehydroepiandrosterone sulphate (DHEAS) with flutamide vs finasteride (MD:  - 0.37 µg/dL; 95% CI  - 0.05 to  - 0.58, p = 0.02, very low-grade evidence), a significant reduction in androstenedione (A4) with rosiglitazone vs placebo (SMD:  - 1.67; 95% CI  - 2.27 to  - 1.06; 59 participants, p < 0.00001, very low-grade evidence), and a significant increase in sex hormone-binding globulin (SHBG) with oral contraceptive pill (OCP) (35 µg Ethinyl Estradiol (EE)/2 mg cyproterone acetate (CPA)) vs placebo (MD: 103.30 nmol/L; 95% CI 55.54-151.05, p < 0.0001, very low-grade evidence) were observed.

CONCLUSION:

Metformin, OCP, dexamethasone, flutamide, and rosiglitazone use were associated with a significant reduction in biochemical hyperandrogenemia in women with PCOS, though their individual use may be limited due to their side effects.

PROSPERO REGISTRATION NO:

CRD42020178783.

• Authors: Mohammed Altigani Abdalla, Najeeb Shah, Harshal Deshmukh, Amirhossein Sahebkar, Linda Östlundh, Rami H Al-Rifai, Stephen L Atkin, Thozhukat Sathyapalan
• Journal: Archives of gynecology and obstetrics (Arch Gynecol Obstet) Vol. 307 Issue 5 Pg. 1347-1376 (05 2023) ISSN: 1432-0711 [Electronic] Germany
• PMID: 35434762 (Publication Type: Meta-Analysis, Systematic Review, Journal Article, Review, Research Support, Non-U.S. Gov't)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Chemical References

• Flutamide
• Androgens
• Rosiglitazone
• Metformin
• Testosterone
• Dexamethasone

Topics

• Female
• Humans
• Polycystic Ovary Syndrome (complications, drug therapy, chemically induced)
• Flutamide (therapeutic use)
• Androgens
• Rosiglitazone (therapeutic use)
• Hyperandrogenism (complications, drug therapy)
• Metformin (therapeutic use)
• Testosterone
• Dexamethasone
• Randomized Controlled Trials as Topic