Effect of interventions on anthropometric outcomes in PCOS varies by drug

In the management of women with polycystic ovary syndrome (PCOS), metformin at various therapeutic doses appears to reduce body weight, body mass index (BMI), and waist circumference (WC) when compared with placebo, sitagliptin, and acarbose, according to the results of a meta-analysis. On the other hand, pioglitazone and rosiglitazone contribute to an increase in all three outcomes.

Researchers reviewed current literature on the effect of different pharmacological interventions on the anthropometric indices in women with PCOS. They searched multiple online databases and identified 80 randomized controlled trials for inclusion in the meta-analysis.

Thirty-one trials reported changes in body weight, 79 in BMI, 23 in WC, and 34 in waist-to-height ratio (WHR). The drugs evaluated were metformin, pioglitazone, liraglutide, rosiglitazone, sitagliptin, orlistat, acarbose, saxagliptin, simvastatin, atorvastatin, and spironolactone.

Pooled data showed that compared with placebo, metformin produced a significant reduction in mean body weight (mean difference [MD], −3.13 kg, 95 percent confidence interval [CI], −5.33 to −0.93; I², percent) and mean BMI (MD, −0.75 kg/m², 95 percent CI, −1.15 to −0.36; I², 0 percent).

Mean BMI also markedly decreased with orlistat versus placebo (MD, −1.33 kg/m², 95 percent CI, −2.16 to −0.66; I², 0.0 percent), acarbose versus metformin (MD, −1.26 kg/m², 95 percent CI, −2.13 to −0.38; I², 0 percent), and metformin versus pioglitazone (MD, −0.91 kg/m², 95 percent CI, −1.62 to −0.19; I², 0 percent).

On the other hand, mean BMI significantly increased with pioglitazone versus placebo (MD, 2.59 kg/m², 95 percent CI, 1.78–3.38; I², 0 percent) and with rosiglitazone versus metformin (MD, 0.80 kg/m², 95 percent CI, 0.32–1.27; I², 3 percent).

Mean WC declined with metformin versus placebo (MD, −1.21 cm, 95 percent CI, −3.71 to 1.29; I², 0 percent) but increased with pioglitazone versus placebo (MD, 5.45 cm, 95 percent CI, 2.18–8.71; I², 0 percent).