GLP-1 receptor agonists versus metformin in PCOS: a systematic review and meta-analysis

Han, Yi; Li, Yingjie; He, Bing

doi:10.1016/j.rbmo.2019.04.017

Cited by 98 publications

(59 citation statements)

References 38 publications

(60 reference statements)

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“…Both animal experiments and clinical research have shown that GLP-1 receptor agonists can reduce serum testosterone concentration in PCOS ( 41 , 42 ), and TZDs were found to repress androgen biosynthesis in thecal cells ( 43 ). Both TMA and NMA showed no significant difference among metformin, GLP-1 receptor agonists, and TZDs in improving TT, FT, and SHBG, which was in accordance with our previous study ( 44 ). However, the meta-analysis done by Niafar et al found that TT decreased significantly after 3 months of GLP-1 receptor agonists treatment ( 42 ), and Li et al found that TZDs were superior to metformin in reducing FT after 12 weeks of treatment ( 45 ).…”

Section: Discussionsupporting

confidence: 92%

Insulin Sensitizers for Improving the Endocrine and Metabolic Profile in Overweight Women With PCOS

Xing

2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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Objective To evaluate the efficacy of insulin sensitizers on menstrual frequency, sex hormone, and metabolic parameters in overweight women with polycystic ovary syndrome (PCOS). Methods We searched multiple databases from inception to September 2019 for randomized controlled trials. Network meta-analysis was conducted using multivariate random effects method. Results Fourteen trials reporting on 619 women were included. Compared with metformin, metformin + thiazolidinediones (TZDs) was more superior in menstrual recovery (weighted mean difference [WMD] 3.68; 95% credibility interval [CrI], 1.65 to 8.20), metformin + glucagon-like peptide-1 (GLP-1) receptor agonists was more effective in decreasing androstenedione (WMD −2.53; 95% CrI, −3.96 to −1.09), both metformin + GLP-1 receptor agonists (WMD 9.22; 95% CrI, 5.46 to 12.98) and metformin + TZDs (WMD 4.30; 95% CrI, 0.78 to 7.82) were more effective in increasing sex hormone–binding globulin (SHBG), while TZDs were less effective in decreasing body mass index (BMI) (WMD 1.69; 95% CrI, 0.72 to 2.66). Compared with GLP-1 receptor agonists, metformin + GLP-1 receptor agonists was associated with higher SHBG (WMD 7.80; 95% CrI, 4.75 to 10.85), lower free testosterone (WMD −1.77; 95% CrI, −3.25 to −0.29), lower androstenedione (WMD −2.70; 95% CrI, −3.91 to −1.50) and lower fasting blood glucose (WMD −0.41; 95% CrI, −0.73 to −0.08). Conclusion For overweight women with PCOS, both metformin combined with GLP-1 receptor agonists and metformin combined with TZDs appear superior to monotherapy in improving hyperandrogenemia. Metformin combined with TZDs could be particularly effective in promoting the recovery of menstruation. Metformin combined with GLP-1 receptor agonists has the additional advantage of improving fasting glucose when compared with GLP-1 receptor agonists alone. TZDs are inferior to metformin in decreasing BMI.

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Section: Discussionsupporting

confidence: 92%

Insulin Sensitizers for Improving the Endocrine and Metabolic Profile in Overweight Women With PCOS

Xing

2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…More recently, a meta-analysis of 8 randomized trials compared the efficacy of GLP-1 RAs versus metformin in women with PCOS ( 95 ). A GLP-1 RA was superior to metformin in improving insulin sensitivity and reducing BMI and abdominal circumference.…”

Section: Liraglutide In Pcosmentioning

confidence: 99%

Obesity, Polycystic Ovary Syndrome, and Infertility: A New Avenue for GLP-1 Receptor Agonists

Cena

Chiovato

Nappi

2020

The Journal of Clinical Endocrinology &Amp; Metabolism

200

104

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Context Obesity is responsible for an increased risk of sub-fecundity and infertility. Obese women show poorer reproductive outcomes regardless of the mode of conception, and higher body mass index (BMI) is associated with poorer fertility prognosis. Polycystic ovary syndrome (PCOS) is one of the leading causes of infertility, and many women with PCOS are also overweight or obese. Evidence Acquisition The aim of the present narrative review is to describe the mechanisms responsible for the development of infertility and PCOS in women with obesity/overweight, with a focus on the emerging role of glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RAs) as a therapeutic option for obese women with PCOS. Evidence synthesis Weight reduction represents the most significant factor affecting fertility and pregnancy outcomes. Current experimental and clinical evidence suggests the presence of an underlying pathophysiological link between obesity, GLP-1 kinetic alterations, and PCOS pathogenesis. Based on the positive results in patients affected by obesity, with or without diabetes, the administration of GLP-1 RA (mainly liraglutide) alone or in combination with metformin has been investigated in women with obesity and PCOS. Several studies demonstrated significant weight loss and testosterone reduction, with mixed results relative to improvements in insulin resistance parameters and menstrual patterns. Conclusions The weight loss effects of GLP-1 RA offer a unique opportunity to expand the treatment options available to PCOS patients.

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“…A recent meta-analysis (134) suggested that orlistat, an antiobesity drug that decreases fat absorption from the intestine, is more effective than metformin in weight loss, LDL and cholesterol level, and IR. Another meta-analysis aimed at evaluating the efficacy and safety of glucagon-like peptide 1 (GLP-1) receptor agonists showed that GLP-1 receptor agonists were more effective than metformin in improving insulin sensitivity and reducing BMI, suggesting that GLP-1 receptor agonists might be a good choice for obese patients with PCOS, especially those with IR (135). However, for both orlistat and GLP-1 receptor agonists, the available evidence is of low quality and therefore inconclusive.…”

Section: Resolution 5: Evidence Supports That Medical Therapy For Wommentioning

confidence: 99%

Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions

et al. 2020

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Polycystic ovary syndrome (PCOS) is a very common endocrine and metabolic disorder with the involvement of both genetic and environmental factors. Although much has been clarified on its pathogenesis, diagnosis, clinical manifestations, and therapy, there are still areas of uncertainty. To address fundamental concepts, novel aspects and hypotheses, and future perspectives, including the possible additional benefits of treatment with nutraceuticals, an expert consensus panel formed by endocrinologists and gynecologists was established. After an independent review of the literature, the panel convened electronically on February 3, 2020, and six resolutions were created, debated, and agreed upon discussion, and finally approved in their final form in a consensus livestream meeting held on April 15. The summary of the resolutions are: (1) PCOS is a well-established medical condition that negatively affects reproduction, general health, sexual health, and quality of life; (2) the symptoms and signs of PCOS appear early in life especially in female newborns from PCOS carriers; (3) women with PCOS have significantly increased risk of pregnancy-related complications including gestational diabetes mellitus; (4) a male PCOS equivalent exists, and it may impact on metabolic health and probably on reproduction; (5) the evidence supports that medical therapy for PCOS is effective, rational, and evidence-based; (6) the evidence supports a major research initiative to explore possible benefits of nutraceutical therapy for PCOS. The proposed resolutions may be regarded as points of agreement based on the current scientific evidence available.

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GLP-1 receptor agonists versus metformin in PCOS: a systematic review and meta-analysis

Cited by 98 publications

References 38 publications

Insulin Sensitizers for Improving the Endocrine and Metabolic Profile in Overweight Women With PCOS

Insulin Sensitizers for Improving the Endocrine and Metabolic Profile in Overweight Women With PCOS

Obesity, Polycystic Ovary Syndrome, and Infertility: A New Avenue for GLP-1 Receptor Agonists

Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions

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