Randomized controlled trial of the effects of metformin versus combined oral contraceptives in adolescent PCOS women through a 24month follow up period

Abstract

Objective: To compare metformin and combined oral contraceptive pill (COC) effects over 24 months in adolescent PCOS. Design: Randomized controlled study. Setting: Alexandria ICSI centre. Patients: 117 adolescent girls with PCOS, were randomized to: group A (n = 40): metformin, group B (n = 40): COC, and group C (n = 39): control. Interventions: Group A: received metformin, group B: received combined oral contraceptives. Main outcome measures: Improvement in cycle rhythm and hirsutism. Results: In group B a significant decline in serum testosterone reached the lowest value by the end of the second year (0.7 ± 0.2 versus 1.3 ± 0.5 lg/ml). By the end of the study, group A showed a significant decline in fasting (18.6 ± 3.0-10.0 ± 3.0 lIU/ml) and after-load insulin levels (126 ± 43-64 ± 15 lIU/ml) with a significant rise in glucose/insulin ratio (GIR) from 4.1 ± 0.3 to 4.6 ± 0.5. Group B showed a significant rise in fasting and after-load insulin (from 15.0 ± 3.0 lIU/ml and 103.0 ± 91.0 lIU/ml to 19.0 ± 4.0 and 187.0 ± 22.0 lIU/ml, respectively) and GIR dropped significantly from 4.4 ± 0.2 to 3.1 ± 0.3. Metformin was associated with a significant loss of weight from 87.0 ± 6.0 to 72.0 ± 0.5 kg while COC was associated with a non-significant gain in weight (from 84.0 ± 6.0 to 91.0 ± 9.0 kg). Conclusions: Metformin and COC have comparable therapeutic effectiveness on cycle regularity and hirsutism. Metformin was associated with a significant improvement in met-* Corresponding author at

Metformin and pioglitazone combination therapy ameliorate polycystic ovary syndrome through AMPK/PI3K/JNK pathway

“…Previous studies have evaluated the treatment with metformin and pioglitazone alone or in different combinations with other drugs for hormone modulation, ovulation induction and insulin resistance in women with PCOS (14,18,19,(35)(36)(37)(38). After metformin monotreatment, circulating testosterone, Δ-4-androstenedione and the hirsutism score in PCOS patients were significantly decreased, indicating that metformin treatment led to a reduction of hyperandrogenism (39).…”

Metformin or Oral Contraceptives for Adolescents With Polycystic Ovarian Syndrome: A Meta-analysis

“…[39][40][41][42] Table 1 reveals the summary of all included studies, Table 2 reveals baseline characteristics for all outcomes, and Supplemental Tables 7, 8, 9, and 10 reveal a detailed summary of each study. All studies used the NIH criteria to diagnose PCOS.…”

“…Three studies excluded current or recent use of metformin or OCP. [40][41][42] None of the studies described the specific ethnic origin of the participants per intervention arm.…”

“…Concealment of allocation was judged to be at low risk of bias for 2 studies 39,42 in which treatment was allocated through sealed envelopes. The other 2 studies were judged to be at high risk of bias.…”

“…42 Three studies [40][41][42] were judged to be at high risk of bias for loss of follow-up (loss to follow-up rate >20% for some treatment arms). Additionally, selective reporting was suspected in 1 study 41 and was therefore rated as high risk of bias because of a large discrepancy between the published abstract and the final study report.…”