Comparative efficacy of oral insulin sensitizers metformin, thiazolidinediones, inositol, and berberine in improving endocrine and metabolic profiles in women with PCOS: a network meta-analysis

Abstract Background Multiple oral insulin-sensitizing agents, such as metformin, thiazolidinediones, inositols, and berberine, have been proven safe efficacious in improving the endocrine, metabolic, reproductive abnormalities seen polycystic ovary syndrome (PCOS), providing more options for healthcare providers patients. These insulin sensitizers are convenient, practical, economic than agents that need to be injected. A comparison of clinical effectiveness four different classes PCOS has not explored, leading uncertainty about optimal treatment pathway. The present study aims compare effects on endocrine metabolic profiles women with PCOS. Methods We identified randomized controlled trials from a variety databases, published January 2005 October 2020. Outcomes included changes menstrual frequency, improvements hyperandrogenism glucolipid metabolism adverse side effects. random-effects network meta-analysis was performed. Results Twenty-two comprising 1079 patients were this study. Compared myo-inositol + d -chiro-inositol associated greater improvement frequency (odds ratio 14.70 [95% confidence interval (CI) 2.31–93.58]). Myo-inositol metformin thiazolidinediones combination therapies superior respective monotherapies reducing total testosterone levels. Thiazolidinediones, lower resistance index (HOMA-IR) compared alone (mean differences: ? 0.72 CI (? 1.11)–(? 0.34)] 0.89 1.460)–(? 0.32)]). Metformin triglyceride levels monotherapy, while increasing high-density lipoprotein cholesterol decreasing fasting plasma glucose, triglycerides, low-density cholesterol, gastrointestinal events. Conclusions Ours is first report PCOS, combined appear testosterone. particularly recovery. Thiazolidinediones improve lipid better alone. Trial registration PROSPERO CRD42020211524