Thiazolidinediones Versus Metformin For Effects And Safety Of Polycystic Ovary Syndrome:A Meta-analysis

Objective: We performed meta-analyses to campare the efficacy and safety of metformin and thiazolidinediones(TZDs), including rosiglitazone and pioglitazone,for the treatment of polycystic ovary syndrome(PCOS). Methods: We followed standard guidelines for performance of meta-analyses to assess the effectiveness and safety of metformin versus thiazolidinediones in the treatment of PCOS. Two independent investigators identified eligible studies through structured keyword searches in databases including Pub Med, MEDLINE(1966 to July 2015), Cochrane Central Register of Controlled Trials and EMBASE(1985 to July 2015) to select randomized controlled trials comparing clinical, hormonal, and metabolic results.Results: Fourteen trials were included. TZDs were superior to metformin in reducing serum luteinizing hormone(MD=-0.31, P < 0.05) and HOMA-IR(MD=-0.63, P < 0.05).Decreases in BMI and cholesterol levels were greater with metformin treatment. There were no significant between-group differences in ovulation, menstrual patterns, serum levels of total testosterone(P=0.06),free testosterone(P=0.92), dehydroepiandrosterone(P=0.63),follicle-stimulating hormone(P=0.69), triglyceride(P=0.06), low-density lipoprotein(P=0.47), high-density lipoprotein(P=0.75), fasting glucose levels(P=0.13) and fasting insulin(P=0.78). Metformin caused a significantly higher incidence of side-effects wtih lowheterogeneity(RR=0.15,P<0.05). Conclusions: The findings from this meta-analysis indicate that TZDs is superior to metformin for the improvment of insulin resistance.And metformin has more advantages for decreasing BMI and TC.Because of the simple dosing schedules of TZDs,good treatment compliance in patients was observed.Clinically,it is suggested that TZDs would be appropriate for treating PCOS patients with obvious insulin resistance.A large scale, well designed, randomized,controlled trial is needed to further address this issue.