Effect of metformin versus metformin plus liraglutide on gonadal and metabolic profiles in overweight patients with polycystic ovary syndrome

Chuan Xing, Han Zhao, Jiaqi Zhang, Bing He, Chuan Xing, Han Zhao, Jiaqi Zhang, Bing He

Abstract

Objective: To observe the effect of metformin (MET) monotherapy versus MET plus liraglutide (LIRA) on gonadal and metabolic profiles in overweight patients with polycystic ovary syndrome (PCOS).

Methods: Sixty overweight patients with PCOS were recruited from January 2021 to January 2022 in Shengjing Hospital of China Medical University and were randomly assigned to the MET or combination (COM) group to receive 12 weeks of MET monotherapy or MET plus LIRA therapy. Anthropometric measurements, menstrual cycle changes, gonadal profiles, and oral glucose tolerance tests (OGTT) were conducted at baseline and after the 12-week treatment.

Results: Fifty-two subjects completed the trial while eight were lost during the follow-up. Both MET and COM improved menstrual cycles, anthropometric parameters, and glucose metabolism after the 12-week treatment; however, there was no statistical difference between the two groups. MET plus LIRA therapy improved hyperandrogenemia, including TT (total testosterone), SHBG (sex hormone binding globulin) and FAI (free androgen index), whereas MET monotherapy only improved SHBG and FAI when compared with baseline. Furthermore, both MET monotherapy and MET plus LIRA therapy improved E2 (estradiol) while only MET plus LIRA therapy improved LH (luteinizing hormone), FSH (follicle stimulating hormone) and Prog (progesterone) more effectively than baseline. Additionally, MET plus LIRA therapy may improve TT, SHBG, FAI, LH and Prog more effectively than MET monotherapy; however, there were no significant differences on E2, FSH and LH/FSH between the two groups.

Conclusions: In overweight patients with PCOS, both MET monotherapy and MET plus LIRA therapy improved glucose metabolism and relieved insulin resistance (IR). Additionally, MET plus LIRA therapy was more effective than MET monotherapy in improving reproductive abnormalities and hyperandrogenemia, potentially by modulating the hypothalamic-pituitary-ovarian axis.

Keywords: gonadal profiles; hyperandrogenemia or androgen excess; liraglutide; metformin; polycystic ovary syndrome.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Xing, Zhao, Zhang and He.

Figures

Figure 1
Figure 1
Flow chart of the study design.
Figure 2
Figure 2
Changes in menstruation and anthropometric measurements after MET and COM therapy. (A) Changes in menstrual cycles after MET and COM therapy. (B) Changes in weight after MET and COM therapy. (C) Changes in BMI after MET and COM therapy. (D) Changes in AG after MET and COM therapy. MET, metformin; COM, combine; BMI, body mass index; AG, abdominal girth. Results are expressed as mean ± SD; *P < 0.05, **P < 0.01 (vs. before treatment in each group).
Figure 3
Figure 3
Changes in metabolic parameters after MET and COM therapy. (A) Changes in FG after MET and COM therapy. (B) Changes in FINS after MET and COM therapy. (C) Changes in HOMA-IR after MET and COM therapy. (D) Changes in AUCglu after MET and COM therapy. (E) Changes in AUCins after MET and COM therapy. (F) Changes in AUCglu/AUCins after MET and COM therapy. (G) Changes in OGTT (glucose) after MET and COM therapy. (H) Changes in OGTT (insulin) after MET and COM therapy. MET, metformin; COM, combine; FG, fasting glucose; FINS, fasting insulin; HOMA-IR, homeostasis model assessment-insulin resistance; AUCglu, area under the curve (AUC) for glucose; AUCins, AUC for insulin. Results are expressed as mean ± SD; *P < 0.05, **P < 0.01 (vs. before treatment in each group).
Figure 4
Figure 4
Changes in gonadal parameters after MET and COM therapy. (A) Changes in E2 after MET and COM therapy. (B) Changes in LH after MET and COM therapy. (C) Changes in FSH after MET and COM therapy. (D) Changes in LH/FSH after MET and COM therapy. (E) Changes in PRL after MET and COM therapy. (F) Changes in Prog after MET and COM therapy. (G) Changes in TT after MET and COM therapy. (H) Changes in SHBG after MET and COM therapy. (I) Changes in FAI after MET and COM therapy. MET, metformin; COM, combine; E2, estradiol; LH, luteinizing hormone; FSH, follicle-stimulating hormone; PRL, prolactin; Prog, progesterone; TT, total testosterone; SHBG, sex hormone-binding globulin; FAI, free androgen index. Results are expressed as mean ± SD or median (25th–75th percentile); *P < 0.05, **P < 0.01 (vs. before treatment in each group); #P < 0.05, ##P < 0.01 (vs. the other treatment).

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