Comparison of the effect between pioglitazone and metformin in treating patients with PCOS:a meta-analysis

Yifeng Xu, Yanxiang Wu, Qin Huang, Yifeng Xu, Yanxiang Wu, Qin Huang

Abstract

Background: Pioglitazone was used to treat patients of PCOS in many researches, but the treatment has not been recognized by public or recommended by all the guidelines.

Method: We conducted a meta-analysis of the related literatures to objectively evaluate the clinical effectiveness and safety by comparing pioglitazone with metformin administrated by PCOS patients. Searches were performed in Cochrane Library, EMBASE and PubMed (last updated December 2016).

Results: Eleven studies among 486 related articles were identified through searches. Fixed effects and random effects models were used to calculate the overall risk estimates. The results of the meta-analysis suggest that improvement of the menstrual cycle and ovulation in pioglitazone treatment group was better than metformin group [OR = 2.31, 95% CI (1.37, 3.91), P < 0.001, I 2 = 41.8%]. Improvement of the F-G scores in metformin treatment group was better than pioglitazone group [SMD = 0.29, 95% CI (0.0, 0.59), P = 0.048, I 2 = 0.0%]. BMI was more elevated in pioglitazone group than in metformin group [SMD = 0.83, 95% CI (0.24, 1.41), P = 0.006, I 2 = 82.8%]. There were no significant differences of the other data between the two groups.

Conclusions: This meta-analysis indicated that pioglitazone ameliorated menstrual cycle and ovulation better than metformin and metformin ameliorated BMI and F-G scores better than pioglitazone in treating patients with PCOS. Pioglitazone might be a good choice for the patients with PCOS who were intolerant or invalid to metformin for the treatment.

Keywords: Metformin; PCOS; Pioglitazone; Therapy.

Conflict of interest statement

Conflict of interest

All the authors declare no conflict of interest.

Ethical approval and informed consent

No patient consent or ethical approval was required because analyses were based on previous published studies.

Figures

Fig. 1
Fig. 1
Search strategy for selection of trials. From: Lesley et al. [48]
Fig. 2
Fig. 2
The effect of pioglitazone or metformin on menstrual cycle and ovulation in patients with polycystic ovary syndrome. Overall pioglitazone superior to metformin. OR Odds ratio, CI confidence interval
Fig. 3
Fig. 3
The effect of pioglitazone or metformin on free testosterone in patients with polycystic ovary syndrome. Overall no differences between two therapies. SMD standardized mean difference, CI confidence interval
Fig. 4
Fig. 4
The effect of pioglitazone or metformin on DHEA in patients with polycystic ovary syndrome. Overall no differences between two therapies. SMD standardized mean difference, CI confidence interval
Fig. 5
Fig. 5
The effect of pioglitazone or metformin on FAI in patients with polycystic ovary syndrome. Overall no differences between two therapies. SMD standardized mean difference, CI confidence interval
Fig. 6
Fig. 6
The effect of pioglitazone or metformin on SHBG in patients with polycystic ovary syndrome. Overall no differences between two therapies. SMD standardized mean difference, CI confidence interval
Fig. 7
Fig. 7
The effect of pioglitazone or metformin on F-G scores in patients with polycystic ovary syndrome. Overall metformin superior to pioglitazone. SMD standardized mean difference, CI confidence interval
Fig. 8
Fig. 8
The effect of pioglitazone or metformin on FBS in patients with polycystic ovary syndrome. Overall no differences between two therapies. SMD standardized mean difference, CI confidence interval
Fig. 9
Fig. 9
The effect of pioglitazone or metformin on INS in patients with polycystic ovary syndrome. Overall no differences between two therapies. SMD standardized mean difference, CI confidence interval
Fig. 10
Fig. 10
The effect of pioglitazone or metformin on HOMA-IR in patients with polycystic ovary syndrome. Overall no differences between two therapies. SMD standardized mean difference, CI confidence interval
Fig. 11
Fig. 11
The effect of pioglitazone or metformin on BMI in patients with polycystic ovary syndrome. Overall pioglitazone added more than metformin. SMD standardized mean difference, CI confidence interval
Fig. 12
Fig. 12
The effect of pioglitazone or metformin on WHR in patients with polycystic ovary syndrome. Overall no differences between two therapies. SMD standardized mean difference, CI confidence interval
Fig. 13
Fig. 13
The effect of pioglitazone or metformin on TC in patients with polycystic ovary syndrome. Overall no differences between two therapies. SMD standardized mean difference, CI confidence interval
Fig. 14
Fig. 14
The effect of pioglitazone or metformin on TG in patients with polycystic ovary syndrome. Overall no differences between two therapies. SMD standardized mean difference, CI confidence interval
Fig. 15
Fig. 15
The Begg’s funnel plot of the literatures
Fig. 16
Fig. 16
Meta-analysis for sensitivity analysis of the literatures

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