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

Abdalla, Mohammed Altigani; Shah, Najeeb; Deshmukh, Harshal; Sahebkar, Amirhossein; Östlundh, Linda; Al-Rifai, Rami H.; Atkin, Stephen L.; Sathyapalan, Thozhukat

Authors

Mohammed Altigani Abdalla

Najeeb Shah

Amirhossein Sahebkar

Linda Östlundh

Rami H. Al-Rifai

Stephen L. Atkin



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.

Citation

Abdalla, M. A., Shah, N., Deshmukh, H., Sahebkar, A., Östlundh, L., Al-Rifai, R. H., …Sathyapalan, T. (in press). Impact of pharmacological interventions on biochemical hyperandrogenemia in women with polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials. Archives of Gynecology and Obstetrics, https://doi.org/10.1007/s00404-022-06549-6

Journal Article Type Review
Acceptance Date Mar 21, 2022
Online Publication Date Apr 18, 2022
Deposit Date Aug 28, 2022
Publicly Available Date Mar 28, 2024
Journal Archives of Gynecology and Obstetrics
Print ISSN 0932-0067
Electronic ISSN 1432-0711
Publisher Springer
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1007/s00404-022-06549-6
Keywords Polycystic ovary syndrome; PCOS; FSH; LH; DHEAS; FAI; Pharmacological therapy
Public URL https://hull-repository.worktribe.com/output/3985623

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Copyright Statement
©2022 The authors.
This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/s00404-022-06549-6




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