Effects of orlistat vs. metformin on weight loss-related clinical variables in women with PCOS: systematic review and meta-analysis

Abstract

Aims: The aim of this study was to assess the effects of orlistat on weight lossrelated clinical variables in overweight/obese women with polycystic ovary syndrome (PCOS) and to compare treatment with orlistat vs. metformin in this group. Methods: We conducted a systematic review and meta-analysis of the evidence about the use of orlistat in women with PCOS. We searched the literature published until May 2015 in MEDLINE, Cochrane Central Register of Controlled Trials and LILACS. Results: Of 3951 studies identified, nine were included in the systematic review (three prospective, non-randomised studies and six randomised control trials). Eight studies used the Rotterdam criteria and 1 used NIH criteria to diagnose PCOS. Data suggest that orlistat promotes a significant reduction in BMI/ weight in overweight/obese PCOS women. Eight studies evaluated orlistat impact on testosterone. Seven reported an improvement in testosterone levels. Eight studies evaluated impact on insulin resistance, and five reported improvement. Finally, five studies evaluated impact on lipid profile, and four reported improvement. Three randomised control trials were included in the fixed effects model meta-analysis for a total of 121 women with PCOS. Orlistat and metformin had similar positive effects on BMI (À0.65%, 95% CI: À2.03 to 0.73), HOMA (À3.60%, 95% CI: À16.99 to 9.78), testosterone (À2.08%, 95% CI: À13.08 to 8.93) and insulin (À5.51%, 95% CI: À22.27 to 11.26). Conclusion(s): The present results suggest that orlistat leads to significant reduction in BMI/body weight in PCOS. In addition, the available evidence indicates that orlistat and metformin have similar effects in reducing BMI, HOMA, testosterone and insulin in overweight/obese PCOS women.This study was registered in PROSPERO under number CRD42014012877. Review criteria• We conducted a systematic review and metaanalysis of the evidence about the effect of orlistat on weight, BMI, androgens and insulin resistance in women with polycystic ovary syndrome.• We systematically searched literature published until May 2015 in electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and LILACS.• We conducted a descriptive systematic review and a fixed effects model meta-analysis and evaluated heterogeneity using the I 2 statistics and Cochran's Q test. Message for the clinic• Orlistat leads to significant reduction in BMI/body weight in overweight/obese PCOS.• Orlistat and metformin have similar effects in reducing BMI, testosterone and insulin/HOMA in overweight/obese PCOS women.

Insulin resistance improvement by cinnamon powder in polycystic ovary syndrome: A randomized double‐blind placebo controlled clinical trial

“…Our result found that decrease serum androgen levels in the cinnamon group did not reach to a statistically significant level. This effect is similar to the observed effect of metformin as a classic insulin‐sanitizing agent that has shown to have androgen‐decreasing effect in patients with PCOS (Dumitrescu, Mehedintu, Briceag, Purcărea, & Hudita, ; Graff, Mario, Ziegelmann, & Spritzer, ).…”

Associations of serum fetuin-A and oxidative stress parameters with polycystic ovary syndrome

“…Although figures vary according to the diagnostic criteria, its incidence is reported to be 6% to 20% [123]. Acne, hirsutism, seborrhoea, menstrual irregularities, anovulation, infertility, obesity, and several metabolic (e.g., glucose and lipid abnormalities) and atherosclerotic disorders are among the symptoms and signs of this disease [45].…”

Pharmacological and surgical treatment of nonreproductive outcomes in polycystic ovary syndrome: An overview of systematic reviews

“…We report that in women with PCOS, bariatric surgery‐induced weight loss, improved hirsutism, blood pressure, glycaemic and lipid profile. Orlistat improved anthropometric, endocrine and metabolic outcomes when compared to placebo but not metformin . However, we acknowledge that there is encouraging evidence in the general population showing that bariatric surgery improves weight loss and metabolic outcomes such as glycaemic control, lipid profile and blood pressure .…”

“…Meta‐analysis of the studies comparing orlistat to placebo was not possible but the systematic review reported improvements in anthropometric (BMI, weight, waist circumference or waist‐hip ratio), endocrine (testosterone) and metabolic outcomes (triglycerides, HDL, LDL, HOMA‐IR and insulin). Meta‐analysis of the studies comparing orlistat to metformin showed no significant differences . Psychological outcomes were not assessed by the above review.…”

“…Seven reviews (n = 3 comparing metformin vs thiazolidinediones, n = 2 comparing metformin vs placebo, n = 1 comparing metformin vs COCPs and n = 1 comparing combination therapy with metformin and clomiphene citrate vs clomiphene citrate alone) reported results favouring metformin in terms of BMI and/or waist‐hip ratio. There was no significant difference in anthropometric outcomes when metformin was compared to acarbose or orlistat, or when combination therapy with metformin and statin was compared to metformin alone . Endocrine outcomes were assessed by 12 reviews.…”