The comparative effectiveness of 55 interventions in obese patients with polycystic ovary syndrome: A network meta-analysis of 101 randomized trials

Autor: Esraa Menshawy, Mohamed Alshandidy, Elfatih A. Hasabo, Mohamed Abdel-Maboud, Mohamed Ibrahim Abdelraoof, Ahmed M. S. Menshawy, Amr Menshawy, Oumaima Outani, Muhammad Eid
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Physiology
Network Meta-Analysis
Overweight
Ethinyl Estradiol
Biochemistry
Geographical locations
law.invention
Flutamide
Body Mass Index
chemistry.chemical_compound
0302 clinical medicine
Sex hormone-binding globulin
Mathematical and Statistical Techniques
Randomized controlled trial
Glucose Metabolism
law
Medicine and Health Sciences
Testosterone
Randomized Controlled Trials as Topic
education.field_of_study
030219 obstetrics & reproductive medicine
Multidisciplinary
biology
Statistics
Metaanalysis
Polycystic ovary
Drug Combinations
Treatment Outcome
Oncology
Physiological Parameters
Meta-analysis
Physical Sciences
Androgens
Carbohydrate Metabolism
Medicine
Egypt
Female
medicine.symptom
Research Article
Polycystic Ovary Syndrome
Adult
medicine.medical_specialty
Asia
Science
Population
030209 endocrinology & metabolism
Research and Analysis Methods
03 medical and health sciences
Internal medicine
medicine
Humans
Obesity
Statistical Methods
education
Cyproterone Acetate
Triglycerides
business.industry
Waist-Hip Ratio
Hyperandrogenism
Body Weight
Biology and Life Sciences
Cancers and Neoplasms
Cholesterol
LDL
medicine.disease
Hormones
United States
Metabolism
chemistry
North America
Africa
biology.protein
People and places
business
Gynecological Tumors
Mathematics
Zdroj: PLoS ONE, Vol 16, Iss 7, p e0254412 (2021)
PLoS ONE
ISSN: 1932-6203
Popis: Background Polycystic ovary syndrome (PCOS) affects up to 18% of reproductive-age females. The prevalence of obesity in PCOS patients reaches up to 80%, which is 2-fold higher than the general population. Objective The present study aimed to compare the effectiveness of 55 pharmacological interventions across 17 different outcomes in overweight/obese PCOS patients with hyperandrogenism manifestations for both short- and long-term follow-ups. A comprehensive literature search was performed on PubMed, Scopus, Embase, Science Direct, Web of Science, and Cochrane CENTRAL for randomized controlled trials comparing any conventional pharmacological intervention as a monotherapy or a combination in overweight/obese patients with polycystic ovary syndrome and hyperandrogenism manifestations. Extracted data included three main parameters; I. Anthropometric parameters (BMI, Waist and Hip circumferences, and Waist/HIP ratio), II. Hormonal parameters (FSH, LH, FSG, SHBG, Estradiol, Total Testosterone, Free testosterone, DHEAS, Androstenedione), and III. Metabolic parameters (Total Cholesterol, LDL-C, HDL-C, Triglycerides, Fasting glucose, Fasting glucose, HOMA-IR). Critical appraisal and risk of bias assessments were performed using the modified Jadad scale, and the overall quality of this network meta-analysis was evaluated according to the CINeMA framework. We performed both a pairwise meta-analysis and a network meta-analysis to evaluate the effect sizes with 95% CI, and we calculated the surface under the cumulative ranking curve (SUCRA) for each intervention. Results Our final search on May 15th 2021 retrieved 23,305 unique citations from searching six electronic databases. Eventually, 101 RCTs of 108 reports with a total of 8,765 patients were included in our systematic review and multi-treatments meta-analysis. 55 different interventions were included: 22 monotherapies, and 33 combinations. The two-dimensional cluster ranking of the average SUCRA values for metabolic and hormonal parameters with significant estimates revealed flutamide (77.5%, 70%; respectively) as the highest and rosiglitazone (38.2%, 26.3%; respectively) as the lowest, in terms of the overall efficacy in reducing weight and hyperandrogenism. However, cyproterone-acetate+ethinylestradiol exhibited a higher ranking in improving hormonal parameters (71.1%), but even a lower-ranking regarding metabolic parameters (34.5%). Conclusions and relevance Current evidence demonstrated the superiority of flutamide in improving both metabolic and hormonal parameters, and the higher efficacy of cyproterone-acetate+ethinylestradiol only in improving hormonal parameters. Nearly all interventions were comparable in female hormones, FGS, HDL, glucose, and insulin levels improvements.
Databáze: OpenAIRE
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