Metformin versus acarbose therapy in patients with polycystic ovary syndrome (PCOS): A prospective randomised double-blind study

Gynecological Endocrinology

Volumn 26, Issue 9, 2010, Pages 690-697

  Hanjalic Beck, Aida ^a   Gabriel, Boris ^a   Schaefer, Wolfgang ^a   Zahradnik, Hans Peter ^a   Schories, Marcus ^b   Tempfer, Clemens ^c   Keck, Christoph ^d   Denschlag, Dominik ^a  

^a UNIVERSITY OF FREIBURG   (Germany)

^b Clinic for Hormonal Disease and Diabetes   (Switzerland)

^c UNIVERSITY OF VIENNA   (Austria)

^d Pan Institut for Endocrinology and Reproductive Medicine   (Germany)

Author keywords

insulin resistance; ovulation induction; Polycystic ovary syndrome

Indexed keywords

ACARBOSE; ANDROSTENEDIONE; CHOLESTEROL; FOLLITROPIN; GLUCOSE; HYDROCORTISONE; INSULIN; LUTEINIZING HORMONE; METFORMIN; PRASTERONE SULFATE; TESTOSTERONE; TRIACYLGLYCEROL;

ADULT; AMENORRHEA; ANDROGEN BLOOD LEVEL; ARTICLE; BODY MASS; CHOLESTEROL BLOOD LEVEL; CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; CONTROLLED STUDY; DIARRHEA; DOUBLE BLIND PROCEDURE; DRUG DOSE INCREASE; DRUG TOLERABILITY; DRUG WITHDRAWAL; FEMALE; FLATULENCE; FOLLITROPIN BLOOD LEVEL; GLUCOSE BLOOD LEVEL; HORMONAL REGULATION; HUMAN; HYDROCORTISONE BLOOD LEVEL; HYPERANDROGENISM; HYPOCHOLESTEROLEMIA; HYPOINSULINEMIA; INSULIN BLOOD LEVEL; LUTEINIZING HORMONE BLOOD LEVEL; MAJOR CLINICAL STUDY; MAXIMUM TOLERATED DOSE; MENSTRUAL CYCLE; METABOLIC REGULATION; NAUSEA; OLIGOMENORRHEA; OVARY POLYCYSTIC DISEASE; OVULATION; PRIORITY JOURNAL; PROSPECTIVE STUDY; RANDOMIZED CONTROLLED TRIAL; TESTOSTERONE BLOOD LEVEL; TRIACYLGLYCEROL BLOOD LEVEL;

ACARBOSE; ADOLESCENT; ADULT; ALGORITHMS; DEHYDROEPIANDROSTERONE SULFATE; DOUBLE-BLIND METHOD; FEMALE; FOLLICLE STIMULATING HORMONE; HUMANS; HYPOGLYCEMIC AGENTS; LUTEINIZING HORMONE; MENSTRUAL CYCLE; METFORMIN; POLYCYSTIC OVARY SYNDROME; PROGESTERONE; TESTOSTERONE; YOUNG ADULT;

EID: 77955812769     PISSN: 09513590     EISSN: 14730766     Source Type: Journal    
DOI: 10.3109/09513591003686379     Document Type: Article

References (37)

1. Franks S. Polycystic ovary syndrome. N Engl J Med 1995;333:853-861.
2. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997;18:774-800.
3. Chang RJ. A practical approach to the diagnosis of polycystic ovary syndrome. Am J Obstet Gynecol 2004;191:713-717.
4. Richardson MR. Current perspectives in polycystic ovary syndrome. Am Fam Physician 2003;68:697-704.
5. Nestler JE, Jakubowicz DJ, de Vargas AF, Brik C, Quintero N, Medina F. Insulin stimulates testosterone biosynthesis by human thecal cells from women with polycystic ovary syndrome by activating its own receptor and using inositolglycan mediators as the signal transduction system. J Clin Endocrinol Metab 1998;83:2001-2005.
6. Azziz R, Ehrmann DA, Legro RS, Fereshetian AG, OKeefe M, Ghazzi MN. PCOS/Troglitazone Study Group. Troglitazone decreases adrenal androgen levels in women with polycystic ovary syndrome. Fertil Steril 2003;79:932-937.
7. Lord JM, Flight IHK, Norman RJ. Insulin-sensitising drugs (metformin, troglitazone, rosiglitazone, pioglitazone, D-chiroinositol) for polycystic ovary syndrome. Cochrane Database Syst Rev 2003;(3):CD003053.
8. Nestler JE, Jakubowicz DJ, Evans WS, Pasquali R. Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. N Engl J Med 1998;338:1876-1880.
9. Chang CT, Chen YC, Fang JT, Huang CC. Metforminassociated lactic acidosis: case reports and literature review. J Nephrol 2002;15:398-402.
10. Coniff RF, Shapiro JA, Robbins D, Kleinfield R, Seaton TB, Beisswenger P, McGill JB. Reduction of glycosylated haemoglobin and postprandial hyperglycaemia by acarbose in patients with NIDDM. A placebo-controlled dose-comparison study. Diabetes Care 1995;18:817-824.
11. Geisthövel F, Frorath B, Brabant G. Acarbose reduces elevated testosterone serum concentrations in hyperinsulinaemic premenopausal women: a pilot study. Hum Reprod 1996;11:2377-2381.
12. Ciotta L, Calogero AE, Farina M, De Leo V, La Marca A, Cianci A. Clinical, endocrine and metabolic effects of acarbose, an alpha-glucosidase inhibitor, in PCOS patients with increased insulin response and normal glucose tolerance. Hum Reprod 2001;16:2066-2072.
13. Penna IA, Canella PR, Reis RM, Silva de SaMF, Ferriani RA. Acarbose in obese patients with polycystic ovarian syndrome: a double-blind, randomized, placebo-controlled study. Hum Reprod 2005;20:2396-2401.
14. Sönmez AS, Yasar L, Savan K, KoçS, Özcan J, Toklar A, Yazicioglu F, Akgün A, Sut N. Comparison of the effects of acarbose and metformin use on ovulation rates in clomiphene citrate-resistant polycystic ovary syndrom. Hum Reprod 2004;20:175-179.
15. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25.
16. Legro RS, Finegood D, Dunaif A. A fasting glucose to insulin ratio is useful measure of insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1998;83:2694-2698.
17. Hughes E, Collins J, Vandekerckhove P. Clomiphene citrate for ovulation induction in women with oligo-amenorrhoea. Cochrane Database Syst Rev 2000;(2):CD000056.
18. Kousta E, White DM, Franks S. Modern use of clomiphene citrate in induction of ovulation. Hum Reprod Update 1997;3:359-365.
19. Pritts EA. Treatment of the infertile patient with polycystic ovarian syndrome. Obstet Gynecol Surv 2002;57:587-597.
20. Barbieri RL. Induction of ovulation in infertile women with hyperandrogenism and insulin resistance. Am J Obstet Gynecol 2000;183:1412-1418.
21. Palomba S, Orio F, Falbo A, Manguso F, Russo T, Cascella T, Tolino A, Carmina E, Colao A, Zullo F. Prospective parallel randomised, double-blind, double-dummy controlled clinical trial comparing clomiphene citrate and metformin as the first-line treatment for ovulation induction in nonobese anovulatory women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005;90:4068-4074.
22. Moghetti P, Castello R, Negri C, Tosi F, Perrone F, Caputo M, Zanolin E, Muggeo M. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomised, double-blind, placebo-controlled 6-month trial, followed by open, long-term clinical evaluation. J Clin Endocrinol Metab 2000;85:139-146.
23. Morin-Papunem LC, Koivunem RM, Ruokonen A, Martikainen HK. Metformin therapy improves the menstrual pattern with minimal endocrine and metabolic effects in women with polycystic ovary syndrome. Fertil Steril 1998;69:691-696.
24. Kocak M, Caliskan E, Simsir C, Haberal A. Metformin therapy improves ovulatory rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome. Fertil Steril 2002;77:101-106.
25. Eisenhardt S, Schwarzmann N, Henschel V, Germeyer A, von Wolff M, Hamann A, Strowitzki T. Early effects of metformin in women with polycystic ovary syndrome: a prospective randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab 2006;91:946-952.
26. Legro RS, Barnhart HX, Schlaff WD, Carr BR, Diamond MP, Carson SA, Steinkampf MP, Coutifaris C, McGovern PG, Cataldo NA. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med 2007;356:551-566.
27. Glueck CJ, Wang P, Fontaine R, Tracy T, Sieve-Smith L. Metformin-induced resumption of normal menses in 39 of 43 (91%) previously amenorrhoeic women with the polycystic ovary syndrome. Metabolism 1999;48:511-519.
28. Velazquez EM, Mendoza S, Hamer T, Sosa F, Glueck CJ. Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogeneamia, and systolic blood pressure, while facilitating normal menses and pregnancy. Metabolism 1994;43:647-654.
29. Barbieri RL. Metformin for the treatment of polycystic ovary syndrome. Obstet Gynecol 2003;101:785-793.
30. Stadtmauer L, Oehninger S. Management of infertility in women with polycystic ovary syndrome. Treat Endocrinol 2005;4:279-292.
31. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M. STOP-NIDDM Trial Research Group. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet 2002;359:2072-2077.
32. Tugrul S, Kutlu T, Pekin O, Baglam E, Kiyak H, Oral O. Clinical, endocrine and metabolic effects of acarbose, a alphaglucosidase inhibitor, in overweight and nonoverweight patients with polycystic ovarian syndrome. Fertil Steril 2008;90:1144-1148.
33. Kashyap S, Wells GA, Rosenwaks Z. Insulin-sensitizing agents as primary therapy for patients with polycystic ovarian syndrome. Hum Reprod 2004;19:2474-2483.
34. DeFronzo RA. Pharmacologic therapy for type 2 diabetes mellitus. Ann Internal Med 1999;131:281-303.
35. Barbieri RL, Ehrmann DA. Metformin for treatment of the polycystic ovary syndrome. UpToDate in Obstetrics, Gynecology and Womens Health 2005.
36. Ho FL, Liew CF, Cunanan EC, Lee KO. Oral hypoglycaemic agents for diabetes in pregnancy-an appraisal of the current evidence for oral anti-diabetic drug use in pregnancy. Ann Acad Med 2007;36:672-678.
37. Zarate A, Ochoa R, Hernandez M, Basurto L. Effectiveness of acarbose in the control of glucose tolerance worsening in pregnancy. Ginecol Obstet Mexico 2000;68:42-45.