Rosiglitazone versus Metformin for Polycystic Ovary Syndrome: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

DU Qiang , YANG Sheng , WU Bo , HAN Ping

Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang 110004, China;

Corresponding author：

Keywords：

Rosiglitazone; Metformin; Polycystic ovary syndrome; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20110171

Video：

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Objective 　To evaluate the efficacy and safety of rosiglitazone versus metformin in treating polycystic ovary syndrome (PCOS).
Methods 　Randomized controlled trials (RCTs) about rosiglitazone versus metformin in treating PCOS were retrieved on computer in MEDLINE, The Cochrane Library, EMbase, EBSCO, CBM, CNKI, Chinese Medical Association Journal Database and VIP from the date of their establishment to December 2010. The trials were screened according to the inclusion and exclusion criteria by two reviewers independently, the data were extracted, the methodological quality was assessed, and finally meta-analysis was conducted with Stata 11.0 software.
Results 　A total of six RCTs involving 286 PCOS patients were included. The results of meta-analyses showed that there was no significant difference between rosiglitazone and metformin in improving PCOS patients’ insulin sensitivity (SMD= –0.14, 95%CI –0.46 to 0.19, P=0.412) and lowering androgen levels (SMD=0.05, 95%CI –0.26 to 0.36, P=0.747). However, the effect of rosiglitazone was inferior to metformin in lowing patients’ weight with a significant difference (SMD=0.34, 95%CI 0.11 to 0.58, P=0.004). The rosiglitazone showed a lower incidence rate of adverse reaction compared with metformin.
Conclusion 　Compared with metformin, the rosiglitazone is eqully effective in improving PCOS patients’ insulin sensitivity and lowering androgen levels, and has a lower incidence rate of adverse reaction although it is inferior to metformin in lowing patients’ weight. So rosiglitazone is more applicable for the patients who are of underweight or cannot tolerate the gastrointestinal side effects induced by metformin. There is no enough evidence for this conclusion due to the small sample size and limited number of RCTs. More high-quality, large-sample and multicentered RCTs are required to guide clinical treatment and benefit patients.

Citation： DU Qiang,YANG Sheng,WU Bo,HAN Ping. Rosiglitazone versus Metformin for Polycystic Ovary Syndrome: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2011, 11(9): 1021-1026. doi: 10.7507/1672-2531.20110171 Copy

1.	1 Radosh L. Drug treatments for polycystic ovary syndrome. Am Fam Physician , 2009, 79(8): 671-676.
2.	Leeman L, Acharya U. The use of metformin in the management of polycystic ovary syndrome and associated anovulatory infertility: the current evidence. J Obstet Gynaecol , 2009, 29(6): 467-72.
3.	Moll E, van der Veen F, van Wely M. The role of metformin in polycystic ovary syndrome: a systematic review. Hum Reprod Update , 2007, 13(6): 527-37.
4.	Costello MF, Eden JA. A systemic review of the reproductive system effects of metformin in patients with polycystic ovary syndrome. Fertil Steril , 2003, 79: 1-13.
5.	Jadad AR, Moore RA, Carroll D, et al . Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials , 1996, 17: 1-12.
6.	Jensterle M, Janez A, Mlinar B, et al . Impact of metformin and rosiglitazone treatment on glucose transporter 4 mRNA expression in women with polycystic ovary syndrome. Eur J Endocrinol , 2008, 158(6): 793-801.
7.	马良坤, 金利娜, 郁琦, 等. 生活方式调整及药物治疗多囊卵巢综合征的临床研究. 中华妇产科学杂志, 2007, 42: 294-297.
8.	Baillargeon JP, Jakubowicz DJ, Iuorno MJ, et al . Effects of metformin and rosiglitazone, alone and in combination, in nonobese women with polycystic ovary syndrome and normal indices of insulin sensitivity. Fertil Steril , 2004, 82(4): 893-902.
9.	Kilicdag EB, Bagis T, Zeyneloglu HB, et al . Homocysteine levels in women with polycystic ovary syndrome treated with metformin versus rosiglitazone: a randomized study. Hum Reprod , 2005, 20(4): 894-899.
10.	孙玉菡, 吴红. 二甲双胍和罗格列酮治疗多囊卵巢综合征的临床疗效观察. 重庆医科大学学报, 2010, 35: 267-270.
11.	Yilmaz M, Karakoç A, Törüner FB, et al . The effects of rosiglitazone and metformin on menstrual cyclicity and hirsutism in polycystic ovary syndrome. Gynecol Endocrinol , 2005, 21(3): 154-160.
12.	Hojlund K, Glintborg D, Andersen NR, et al . Impaired insulin-stimulated phosphorylation of Akt and AS160 in skeletal muscle of women with polycystic ovary syndrome is reversed by pioglitazone treatment. Diabetes , 2008, 2: 357-366.
13.	Haller K, Laisk T, Peters M, et al . VNTR I/I genotype of insulin gene is associated with the increase of follicle number independent from polycystic ovary syndrome. Acta Obstet Gynecol Scand , 2007, 86(6): 726-732.
14.	Waterworth DM, Bennett ST, Gharani N, et al . Linkage and association of insulin gene VNTR regulatory polymorphism with polycystic ovary syndrome. Lancet , 1997, 349(9057): 986-990.
15.	张俊英, 马彬, 杨克虎, 等. 二甲双胍和罗格列酮联用治疗2型糖尿病的系统评价. 中国循证医学杂志, 2009, 4: 437-445.
16.	Schoppee PD, Garmey JC, Veldhuis JD. Putative activation of the peroxisome proliferator-activated receptor γ impairs androgen and enhances progesterone biosynthesis in primary cultures of porcine theca cells. Biology of Reproduction , 2002, 66(1): 190-198.
17.	Balfour JA, Plosker GL. Rosiglitazone. Drugs , 1999, 57: 921-930.

1. 1 Radosh L. Drug treatments for polycystic ovary syndrome. Am Fam Physician , 2009, 79(8): 671-676.
2. Leeman L, Acharya U. The use of metformin in the management of polycystic ovary syndrome and associated anovulatory infertility: the current evidence. J Obstet Gynaecol , 2009, 29(6): 467-72.
3. Moll E, van der Veen F, van Wely M. The role of metformin in polycystic ovary syndrome: a systematic review. Hum Reprod Update , 2007, 13(6): 527-37.
4. Costello MF, Eden JA. A systemic review of the reproductive system effects of metformin in patients with polycystic ovary syndrome. Fertil Steril , 2003, 79: 1-13.
5. Jadad AR, Moore RA, Carroll D, et al . Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials , 1996, 17: 1-12.
6. Jensterle M, Janez A, Mlinar B, et al . Impact of metformin and rosiglitazone treatment on glucose transporter 4 mRNA expression in women with polycystic ovary syndrome. Eur J Endocrinol , 2008, 158(6): 793-801.
7. 马良坤, 金利娜, 郁琦, 等. 生活方式调整及药物治疗多囊卵巢综合征的临床研究. 中华妇产科学杂志, 2007, 42: 294-297.
8. Baillargeon JP, Jakubowicz DJ, Iuorno MJ, et al . Effects of metformin and rosiglitazone, alone and in combination, in nonobese women with polycystic ovary syndrome and normal indices of insulin sensitivity. Fertil Steril , 2004, 82(4): 893-902.
9. Kilicdag EB, Bagis T, Zeyneloglu HB, et al . Homocysteine levels in women with polycystic ovary syndrome treated with metformin versus rosiglitazone: a randomized study. Hum Reprod , 2005, 20(4): 894-899.
10. 孙玉菡, 吴红. 二甲双胍和罗格列酮治疗多囊卵巢综合征的临床疗效观察. 重庆医科大学学报, 2010, 35: 267-270.
11. Yilmaz M, Karakoç A, Törüner FB, et al . The effects of rosiglitazone and metformin on menstrual cyclicity and hirsutism in polycystic ovary syndrome. Gynecol Endocrinol , 2005, 21(3): 154-160.
12. Hojlund K, Glintborg D, Andersen NR, et al . Impaired insulin-stimulated phosphorylation of Akt and AS160 in skeletal muscle of women with polycystic ovary syndrome is reversed by pioglitazone treatment. Diabetes , 2008, 2: 357-366.
13. Haller K, Laisk T, Peters M, et al . VNTR I/I genotype of insulin gene is associated with the increase of follicle number independent from polycystic ovary syndrome. Acta Obstet Gynecol Scand , 2007, 86(6): 726-732.
14. Waterworth DM, Bennett ST, Gharani N, et al . Linkage and association of insulin gene VNTR regulatory polymorphism with polycystic ovary syndrome. Lancet , 1997, 349(9057): 986-990.
15. 张俊英, 马彬, 杨克虎, 等. 二甲双胍和罗格列酮联用治疗2型糖尿病的系统评价. 中国循证医学杂志, 2009, 4: 437-445.
16. Schoppee PD, Garmey JC, Veldhuis JD. Putative activation of the peroxisome proliferator-activated receptor γ impairs androgen and enhances progesterone biosynthesis in primary cultures of porcine theca cells. Biology of Reproduction , 2002, 66(1): 190-198.
17. Balfour JA, Plosker GL. Rosiglitazone. Drugs , 1999, 57: 921-930.

Chinese Journal of Evidence-Based Medicine

Rosiglitazone versus Metformin for Polycystic Ovary Syndrome: A Systematic Review

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