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

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: Apr 19, 2023
• 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