Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, 13578 Taif Rd, Makkah, 21955, Saudi Arabia.
Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh, 11451, Saudi Arabia.
BMC Womens Health. 2020 Apr 5;20(1):68. doi: 10.1186/s12905-020-00919-5.
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.
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.
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).
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.
多囊卵巢综合征（PCOS）是一种影响约 10%育龄期妇女的内分泌疾病，与多种激素异常有关，包括高雄激素血症和不孕，所有这些都可能导致 PCOS。他汀类药物以前被引入作为降低 PCOS 妇女睾酮水平的治疗选择，单独使用或与二甲双胍联合使用。本研究旨在评估不同他汀类药物单独或与二甲双胍联合使用在降低 PCOS 妇女睾酮水平方面的疗效。
检索 Medline、Embase 和 clinicaltrials.gov 以寻找研究他汀类药物、二甲双胍、螺内酯或联合口服避孕药（COC）单独或联合使用降低 PCOS 患者睾酮水平的疗效的研究。搜索仅限于随机临床试验，并根据系统评价和荟萃分析的首选报告项目 - 网络荟萃分析扩展声明（PRISMA-NMA）进行。使用 Cochrane 协作风险偏倚（RoB）评估工具评估纳入研究的质量。使用随机效应模型的频率主义网络荟萃分析评估降低睾酮水平的疗效，并表示为比值比（OR）和 95%可信区间（95%CrI）。所有统计分析均使用 R 统计软件包中的 netmeta 版本 1.0 进行。
纳入了 9 项 RCT，涉及 613 名患者。阿托伐他汀与 COC 相比，降低睾酮水平的效果更好（MD -2.78，95%CrI -3.60，-1.97），螺内酯加二甲双胍（MD -2.83，95%CrI -3.80，-1.87），辛伐他汀（MD -2.88，95%CrI -3.85，-1.92），螺内酯（MD -2.90，95%CI -3.77，-2.02），辛伐他汀加二甲双胍（MD -2.93，95%CrI -3.79，-2.06），二甲双胍（MD -2.97，95%CrI -3.69，-2.25），生活方式改变（MD -3.02，95%CrI -3.87，-2.18），安慰剂（MD -3.04，95%CrI -3.56，-2.53）。
阿托伐他汀在降低 PCOS 患者的总睾酮水平方面比其他治疗策略更有效。未来的研究应侧重于最佳剂量。
