Department of Medicine, Cesmac University Center, Maceió, Brazil.
Department of Medicine, State University of Maringá, Maringá, Brazil.
J Diabetes Complications. 2024 Oct;38(10):108834. doi: 10.1016/j.jdiacomp.2024.108834. Epub 2024 Aug 20.
The efficacy of GLP1 receptor agonists (GLP1-RAs) in treating polycystic ovarian syndrome (PCOS) remains unclear. While GLP1-RAs are known to promote weight loss in patients with diabetes and living with obesity, their impact on weight reduction and hormonal regulation in women with PCOS is understudied. Therefore, we aimed to assess the efficacy of GLP1-RAs in PCOS women living with obesity through a meta-analysis, comparing their effects to placebo.
The use of GLP1-RAs in PCOS women living with obesity can reduce body mass index and waist circumference as well as improve hyperinsulinism, and hyperandrogenism as well as normalize total testosterone, total cholesterol and HOMA-IR markers in PCOS women living with obesity.
We systematically searched the PubMed, Cochrane Central, Scopus and Embase databases to identify randomized controlled trials (RCT) comparing GLP1-RAs versus placebo among women diagnosed with PCOS based on the Rotterdam Criteria. Our primary outcomes of interest included body mass index (BMI), triglycerides, waist circumference, total testosterone, total cholesterol, and HOMA-IR. We performed data extraction and quality assessment for studies that met the inclusion criteria. We pooled mean difference (MD) and 95 % confidence intervals (CI) with a random-effect model for continuous endpoints.
We included 176 participants from four RCTs. Semaglutide and Liraglutide were used in 23 (13 %) and 103 (58 %) participants, respectively. GLP1-RAs use was associated with a significant reduction in waist circumference (MD: -5.16 cm; 95 % CI: -6.11 to -4.21; p ˂ 0.00001), body mass index (BMI) (MD: -2.42; 95 % CI: -3.10 to -1.74; p ˂ 0.00001), serum triglycerides (MD: -0.20; 95 % CI: -0.30 to -0.11; p ˂ 0.00001) and total testosterone levels (MD: -1.33; 95 % CI: -2.55 to -0.12; p = 0.03) when compared to placebo. There was no significant difference in total cholesterol (MD: -0.04; 95 % CI: -0.10 to 0.01; p = 0.15) and HOMA-IR (MD: -0.30; 95 % CI: -0.92 to 0.32; p = 0.35) levels. Adverse events information was available for 112 patients, where 49 had light side effects such as nausea and abdominal pain.
The use of GLP1-RAs demonstrates efficacy in reducing BMI, triglycerides, waist circumference and total testosterone. There was no significant difference in total cholesterol and HOMA-IR levels. These results signify its viability as a favourable treatment option for managing PCOS symptoms in women living with obesity.
GLP1 受体激动剂（GLP1-RAs）在治疗多囊卵巢综合征（PCOS）方面的疗效尚不清楚。虽然 GLP1-RAs 已知可促进糖尿病和肥胖患者的体重减轻，但它们对 PCOS 患者体重减轻和激素调节的影响仍研究不足。因此，我们旨在通过荟萃分析评估 GLP1-RAs 在肥胖 PCOS 女性中的疗效，将其与安慰剂进行比较。
在肥胖的 PCOS 女性中使用 GLP1-RAs 可以降低体重指数和腰围，改善高胰岛素血症和高雄激素血症，并使肥胖的 PCOS 女性的总睾酮、总胆固醇和 HOMA-IR 标志物正常化。
我们系统地检索了 PubMed、Cochrane 中心、Scopus 和 Embase 数据库，以确定基于 Rotterdam 标准诊断为 PCOS 的女性中 GLP1-RAs 与安慰剂相比的随机对照试验（RCT）。我们感兴趣的主要结局包括体重指数（BMI）、甘油三酯、腰围、总睾酮、总胆固醇和 HOMA-IR。我们对符合纳入标准的研究进行了数据提取和质量评估。我们使用随机效应模型对连续终点进行了均值差（MD）和 95%置信区间（CI）的合并。
我们纳入了来自四项 RCT 的 176 名参与者。在 23 名（13%）和 103 名（58%）参与者中分别使用了司美格鲁肽和利拉鲁肽。GLP1-RAs 的使用与腰围显著减少（MD：-5.16cm；95%CI：-6.11 至-4.21；p<0.00001）、体重指数（BMI）（MD：-2.42；95%CI：-3.10 至-1.74；p<0.00001）、血清甘油三酯（MD：-0.20；95%CI：-0.30 至-0.11；p<0.00001）和总睾酮水平（MD：-1.33；95%CI：-2.55 至-0.12；p=0.03）有关，与安慰剂相比。总胆固醇（MD：-0.04；95%CI：-0.10 至 0.01；p=0.15）和 HOMA-IR（MD：-0.30；95%CI：-0.92 至 0.32；p=0.35）水平无显著差异。112 名患者提供了不良反应信息，其中 49 名出现轻度副作用，如恶心和腹痛。
GLP1-RAs 的使用在降低 BMI、甘油三酯、腰围和总睾酮方面具有疗效。总胆固醇和 HOMA-IR 水平无显著差异。这些结果表明，它作为一种治疗肥胖 PCOS 女性症状的有利选择具有可行性。
