Comparative efficacy of statins, metformin, spironolactone and combined oral contraceptives in reducing testosterone levels in women with polycystic ovary syndrome: a network meta-analysis of randomized clinical trials.

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  • Additional Information
    • Affiliation:
      Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, 13578 Taif Rd, 21955, Makkah, Saudi Arabia
      Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, 11451, Riyadh, Saudi Arabia
    • Abstract:
      Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting about 10% of women in reproductive age and associated with a variety of hormonal abnormalities, including hyperandrogenemia and infertility, all of which could lead to PCOS. Statins were previously introduced as a therapeutic option for reducing testosterone levels in women with PCOS, either alone or in combination. The aim of this study is to evaluate the effectiveness of different statins alone or in combination with metformin in reducing testosterone levels in women with PCOS.Methods: Medline, Embase, and clinicaltrials.gov were searched for studies that investigated the efficacy of statins, metformin, spironolactone, or combined oral contraceptives (COCs), individually or in combination, in reducing the testosterone level in patients with PCOS. The search was limited to randomized clinical trials and conducted according to the preferred reporting items for systematic reviews and meta-analyses - extension statement for network meta-analyses (PRISMA-NMA). The quality of included studies was assessed using the Cochrane Collaboration risk of bias (RoB) assessment tool. A frequentist network meta-analysis using random-effects models was used to assess the efficacy in reducing testosterone level and were expressed as odds ratios (OR) and 95% credible interval (95%Crl). All statistical analyses were performed using netmeta Version 1.0 on R statistical package.Result: Nine RCTs involving 613 patients were included. Atorvastatin showed greater reduction in testosterone level compared to COC (MD -2.78, 95%CrI -3.60, -1.97), spironolactone plus metformin (MD -2.83, 95%CrI -3.80, -1.87), simvastatin (MD -2.88, 95%CrI -3.85, -1.92), spironolactone (MD -2.90, 95%CI -3.77, -2.02), simvastatin plus metformin (MD -2.93, 95%CrI -3.79, -2.06), metformin (MD -2.97, 95%CrI -3.69, -2.25), lifestyle modification (MD -3.02, 95%CrI -3.87, -2.18), and placebo (MD -3.04, 95%CrI -3.56, -2.53).Conclusion: Atorvastatin was found to be more effective than the other management strategies in reducing the total testosterone level for patients with PCOS. Future studies should focus on the optimal dose.
    • Journal Subset:
      Biomedical; Europe; UK & Ireland
    • ISSN:
      1472-6874
    • MEDLINE Info:
      PMID: NLM32248801 NLM UID: 101088690
    • Grant Information:
      RSP-2019/77//King Saud University/
    • Publication Date:
      In Process
    • Publication Date:
      20200502
    • DOI:
      http://dx.doi.org/10.1186/s12905-020-00919-5
    • Accession Number:
      142576084
  • Citations
    • ABNT:
      ALMALKI, H. H. et al. Comparative efficacy of statins, metformin, spironolactone and combined oral contraceptives in reducing testosterone levels in women with polycystic ovary syndrome: a network meta-analysis of randomized clinical trials. BMC Women’s Health, [s. l.], v. 20, n. 1, p. 1–6, 2020. DOI 10.1186/s12905-020-00919-5. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=142576084. Acesso em: 15 ago. 2020.
    • AMA:
      Almalki HH, Alshibani TM, Alhifany AA, Almohammed OA. Comparative efficacy of statins, metformin, spironolactone and combined oral contraceptives in reducing testosterone levels in women with polycystic ovary syndrome: a network meta-analysis of randomized clinical trials. BMC Women’s Health. 2020;20(1):1-6. doi:10.1186/s12905-020-00919-5
    • APA:
      Almalki, H. H., Alshibani, T. M., Alhifany, A. A., & Almohammed, O. A. (2020). Comparative efficacy of statins, metformin, spironolactone and combined oral contraceptives in reducing testosterone levels in women with polycystic ovary syndrome: a network meta-analysis of randomized clinical trials. BMC Women’s Health, 20(1), 1–6. https://doi.org/10.1186/s12905-020-00919-5
    • Chicago/Turabian: Author-Date:
      Almalki, Hussain H., Turki M. Alshibani, Abdullah A. Alhifany, and Omar A. Almohammed. 2020. “Comparative Efficacy of Statins, Metformin, Spironolactone and Combined Oral Contraceptives in Reducing Testosterone Levels in Women with Polycystic Ovary Syndrome: A Network Meta-Analysis of Randomized Clinical Trials.” BMC Women’s Health 20 (1): 1–6. doi:10.1186/s12905-020-00919-5.
    • Harvard:
      Almalki, H. H. et al. (2020) ‘Comparative efficacy of statins, metformin, spironolactone and combined oral contraceptives in reducing testosterone levels in women with polycystic ovary syndrome: a network meta-analysis of randomized clinical trials’, BMC Women’s Health, 20(1), pp. 1–6. doi: 10.1186/s12905-020-00919-5.
    • Harvard: Australian:
      Almalki, HH, Alshibani, TM, Alhifany, AA & Almohammed, OA 2020, ‘Comparative efficacy of statins, metformin, spironolactone and combined oral contraceptives in reducing testosterone levels in women with polycystic ovary syndrome: a network meta-analysis of randomized clinical trials’, BMC Women’s Health, vol. 20, no. 1, pp. 1–6, viewed 15 August 2020, .
    • MLA:
      Almalki, Hussain H., et al. “Comparative Efficacy of Statins, Metformin, Spironolactone and Combined Oral Contraceptives in Reducing Testosterone Levels in Women with Polycystic Ovary Syndrome: A Network Meta-Analysis of Randomized Clinical Trials.” BMC Women’s Health, vol. 20, no. 1, Apr. 2020, pp. 1–6. EBSCOhost, doi:10.1186/s12905-020-00919-5.
    • Chicago/Turabian: Humanities:
      Almalki, Hussain H., Turki M. Alshibani, Abdullah A. Alhifany, and Omar A. Almohammed. “Comparative Efficacy of Statins, Metformin, Spironolactone and Combined Oral Contraceptives in Reducing Testosterone Levels in Women with Polycystic Ovary Syndrome: A Network Meta-Analysis of Randomized Clinical Trials.” BMC Women’s Health 20, no. 1 (April 5, 2020): 1–6. doi:10.1186/s12905-020-00919-5.
    • Vancouver/ICMJE:
      Almalki HH, Alshibani TM, Alhifany AA, Almohammed OA. Comparative efficacy of statins, metformin, spironolactone and combined oral contraceptives in reducing testosterone levels in women with polycystic ovary syndrome: a network meta-analysis of randomized clinical trials. BMC Women’s Health [Internet]. 2020 Apr 5 [cited 2020 Aug 15];20(1):1–6. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=142576084