Comparison of the efficacy between NAC and metformin in treating PCOS patients: a meta-analysis

Song, Yu; Wang, Huimin; Huang, Hongli; Zhu, Zhengyan

doi:10.1080/09513590.2019.1689553

Cited by 17 publications

(5 citation statements)

References 34 publications

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“… Mamas et al [ 69 ] reported that alternately spliced variants of FSHR may be associated with poor or high response to exogenous FSH. Song et al [ 70 ] investigated FSH induced proliferation of epithelial ovarian cancer cells is not mediated via cAMP. To conclude, rather than genetic changes (mutations, SNPs) in the canonical FSHR, differential expression of FSHR isoforms may have a greater relevance to explain various ovarian/testicular biology and pathologies.…”

Section: Relevance Of Studies Reported On Fshr Isoformsmentioning

confidence: 99%

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An overview of FSH-FSHR biology and explaining the existing conundrums

Bhartiya

Patel

2021

J Ovarian Res

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FSH was first identified in 1930 and is central to mammalian reproduction. It is indeed intriguing that despite being researched upon for about 90 years, there is still so much more to learn about FSH-FSHR biology. The purpose of this review is to provide an overview of current understanding of FSH-FSHR biology, to review published data on biological and clinical relevance of reported mutations, polymorphisms and alternately spliced isoforms of FSHR. Tissue-resident stem/progenitor cells in multiple adult tissues including ovaries, testes and uterus express FSHR and this observation results in a paradigm shift in the field. The results suggest a direct action of FSH on the stem cells in addition to their well-studied action on Granulosa and Sertoli cells in the ovaries and testes respectively. Present review further addresses various concerns raised in recent times by the scientific community regarding extragonadal expression of FSHR, especially in cancers affecting multiple organs. Similar population of primitive and pluripotent tissue-resident stem cells expressing FSHR exist in multiple adult tissues including bone marrow and reproductive tissues and help maintain homeostasis throughout life. Any dysfunction of these stem cells results in various pathologies and they also most likely get transformed into cancer stem cells and initiate cancer. This explains why multiple solid as well as liquid tumors express OCT-4 and FSHR. More research efforts need to be focused on alternately spliced FSHR isoforms.

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Section: Relevance Of Studies Reported On Fshr Isoformsmentioning

confidence: 99%

“…Song et al [ 70 ] investigated FSH induced proliferation of epithelial ovarian cancer cells is not mediated via cAMP.…”

Section: Relevance Of Studies Reported On Fshr Isoformsmentioning

confidence: 99%

An overview of FSH-FSHR biology and explaining the existing conundrums

Bhartiya

Patel

2021

J Ovarian Res

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“…We also found a significant increase in FBG when metformin was compared with NAC. However, a recent meta‐analysis of RCTs that compared the efficacy of metformin versus NAC showed no significant changes in the parameters of IR 95 . This review did not establish any significant effect on HOMA‐B with various pharmacological interventions used in the management of PCOS.…”

Section: Discussionmentioning

confidence: 64%

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

Abdalla

Shah

Deshmukh

et al. 2021

Clinical Endocrinology

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Objective Polycystic ovary syndrome (PCOS) is a complex endocrine condition affecting women of reproductive age. It is characterized by insulin resistance and is a major risk factor for type 2 diabetes mellitus (T2DM). The objective was to review the literature on the effect of different pharmacological interventions on insulin resistance in women with PCOS. Design We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library and the Web of Science in April 2020 and updated in March 2021. The study follows the 2020 Preferred Reporting Items for Systematic reviews and Meta‐ana. Reviwers extracted data and assessed the risk of bias using the Cochrane risk of bias tool. Results In 58 randomized controlled trials there were significant reductions in the fasting blood glucose (FBG) with metformin versus placebo (standardized mean difference [SMD]: −0.23; 95% confidence interval [CI]: −0.40, −0.06; I² = 0%, low‐grade evidence), and acarbose versus metformin (mean difference [MD]: −10.50 mg/dl; 95% CI: −15.76, −5.24; I² = 0%, low‐grade evidence). Significant reductions in fasting insulin (FI) with pioglitazone versus placebo (SMD: −0.55; 95% CI: −1.03, −0.07; I² = 37%; p = .02, very‐low‐grade evidence). A significant reduction in homoeostatic model assessment of insulin resistance (HOMA‐IR) was seen with exenatide versus metformin (MD: −0.34; 95% CI: −0.65, −0.03; I² = 0%, low‐grade evidence). No effect on homoeostatic model assessment of beta cells (HOMA‐B) was observed. Conclusions Pharmacological interventions, including metformin, acarbose, pioglitazone and exenatide have significant effects on FBG, FI, HOMA‐IR but not on HOMA‐B.

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“…According to previous reports, [42,43] metformin can significantly reduce FBS levels, but cannot reduce CRP levels, and metformin combined with simvastatin can reduce BMI and TG levels, but does not change HDL levels. Other studies [36,44,45] have shown that simvastatin significantly reduces some biochemical parameters, such as FSH, LH, T, Tc, LDL, and increases HDL levels, while metformin significantly reduces FSH, T, and TC levels. This study further showed that the difference between metformin combined with simvastatin and metformin in reducing FSH levels is not statistically significant, but has a significant effect in reducing LDL levels, but it does not reduce luteinizing hormone levels.…”

Section: Discussionmentioning

confidence: 93%

The efficacy and safety of metformin combined with simvastatin in the treatment of polycystic ovary syndrome

Liu¹,

Shao²,

Xie³

et al. 2021

Medicine

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Background: Several previous randomized controlled trials (RCTs) evaluated the efficacy of metformin combined with simvastatin in the treatment of polycystic ovary syndrome (PCOS), yet the results of the researches are not consistent. It is necessary to conduct a meta-analysis to explore the efficacy and safety of metformin combined with simvastatin in the treatment of PCOS, to provide evidence supports for the treatment of PCOS.Methods: We searched PubMed, EMbase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and Chinese biomedical literature databases online to identify the RCTs evaluating the efficacy of metformin combined with simvastatin in the treatment of PCOS. Standardized mean difference (SMD) and 95% confidence interval (95% CI) were calculated to evaluate the synthesized effects.Results: Nine RCTs with a total of 746 PCOS patients were included. The synthesized results indicated that the combined use of metformin and simvastatin are more beneficial to reduce the total cholesterol (SMD -2.66, 95% CI -3.65 to -1.66), triglycerides (SMD -1.25, 95% CI -2.02 to -0.49), low density lipoprotein (SMD -2.91, 95% CI -3.98 to -1.84), testosterone (SMD -0.64, 95% CI -1.13 to -0.15), fasting insulin (SMD -1.17, 95% CI -2.09 to -0.26) than metformin alone treatment in PCOS patients (all P < .001), and there was no significant difference in the high density lipoprotein (SMD -0.05, 95% CI -0.56-0.46), luteinizing hormone (SMD -0.58, 95% CI -1.66 to -0.50), follicle stimulating hormone (SMD 0.41, 95% CI -0.78-1.59), prolactin (SMD -1.38, 95% CI -2.93-0.17), fasting blood sugar (SMD 0.23, 95% CI -0.52-0.97), and insulin sensitivity index (SMD -0.17, 95% CI -0.48-0.15) between experimental and control groups (all P > .05).Conclusions: Metformin combined with simvastatin is superior to metformin alone in the treatment of PCOS patients with more advantages in improving the levels of sex hormones, blood lipids, and blood sugar. However, the safety of this therapy still needs to be further explored in clinical studies with high-quality and large samples. Abbreviations: 95% CI = 95% confidence interval, FBS = fasting blood sugar, FIN = fasting insulin, FSH = follicle stimulating hormone, HDL = high density lipoprotein, LDL = low density lipoprotein, OR = odds ratio, PCOS = polycystic ovary syndrome, RCT = randomized controlled trial, SMD = standardized mean difference, T = testosterone, TC = total cholesterol, TG = triglycerides.

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Comparison of the efficacy between NAC and metformin in treating PCOS patients: a meta-analysis

Cited by 17 publications

References 34 publications

An overview of FSH-FSHR biology and explaining the existing conundrums

An overview of FSH-FSHR biology and explaining the existing conundrums

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

The efficacy and safety of metformin combined with simvastatin in the treatment of polycystic ovary syndrome

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