Meta-analysis For The Comparison Of Efficacy And Safety Between Thiazolidinediones And Methformin In Treatment Of Polycystic Ovary Syndrome

To assess the comparison of clinical efficacy and safety between thiazolidinediones(rosiglitazone or pioglitazone) and metformin in treatment of polycystic ovary syndrome, evaluatet the advantages of the TZDs treatment and finally provide relevant suggestion for clinical treatment.[Methods] Electronic database searching was performed on Cochrane Library,PubMed,EMCC,OVID,Chinese biology and medicine(CBM),China National Knowledge Infrastructure (CNKI),and Chongqing VIP Database; meanwhile,CALIS,CDDB,CDMD were also searchedy. The data included those from the establishment to April 2011.Randomized or clinical controlled trials concerning each of rosiglitazone and pioglitazone versus metformin single therapy for PCOS were selected and assessed for the methodological quality, and Meta-analysis was performed using statistical software Revman 5. 0.[Results]1. Sixteen randomized controlled trials met the inclusion criteria and were included.2. Compared to metformin group, TZDs more significantly improved insulin resistance[P =0.02,WMD =-0.21,95%CI(- 0.39,-0.03)] and reduced fasting insulin concentrations[P =0.06,WMD =-0.17,95%CI(- 0.35,0.01)]. Meanwhile,there were significantly higher levels of serum HDL and lower levels of serum LDL after treating in TZDs groups than metformin groups, statistically significant difference between the two groups[P =0.004,WMD =0.36,95%CI(0.12,0.59)]and [P =0.003,WMD =-0.37,95%CI(-0.61,-0.13)]. They more promoted ovulation rate, increased pregnancy rate, reduced the levels of FBG and TC although there were no statistically significant difference between the two groups (P=0.21,0.25,0.49,0.32).There were similar functions in both LH and FSH(P=0.94,0.89).However,BMI was increased after TZDs therapy. There were no serious adverse events during the treatment and patients'obedience was better.[Conclusion] TZDs can greatly improve of insulin resistance and reduced fasting insulin concentrations; Besides,it more benefit in increasing serum HDL levels and decreasing serum LDL levels. However, they resulted in adverse reaction of slight BMI increasing due to the redistribute of fat. Because TZDs were taken simply,patients'obedience was better. There were no serious adverse events. Because the safety use of rosiglitazone had been warned for its cardiovascular events, the clinical recommen- dations could be suggested that pioglitazone tremeant should be the first choice for patients with PCOS who suffered with greatly insulin resistance, specifically with moderate to severe obesity and/or with the metabolic syndrome or to improve insulin resistance, increase on insulin sensitivity for therapeutic purposes.