Reply: Metformin in therapy naive patients with polycystic ovary syndrome
Abstract
Sir, The literature on metformin and polycystic ovary syndrome includes a lot of confusing information about the type of patient and the type and amount of medication. Our review attempted to clearly distinguish the type of patients, therapies and comparisons. One of the comparisons is clomiphene versus clomiphene plus metformin. When we look at these data, there is no doubt that metformin does not have an additional role next to clomiphene in naïve patients in reaching a live birth. The pooled relative risk for live birth was 1.0 (95% CI 0.82–1.3; three trials with 664 women). Two studies reported multiple pregnancy rates (Moll et al., 2006; Legro et al., 2007). After combining these data no significant difference was seen (RR 0.38; 95% CI 0.09–1.5; 193 women). The suggestion of excluding the articles of Khorram et al. (2006) and Sahin et al. (2004) is not correct. Khorram et al. randomized patients between metformin plus clomiphene and clomiphene alone. Metformin was started in the same cycle as was clomiphene. Sahin et al. did treat the patients with metformin 3 months prior to administrating clomiphene, but all patients also received clomiphene, which also makes the comparison justifiable. Both these studies together counted for 52 of 985 patients (5%) in this particular comparison. Obviously, there is no argument against more data as the estimation of the truth will thereby improve.
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 664 participants or records.
Read the paper
Related studies
- Metformin as an adjuvant in breast cancer treatment
- Metformin Lysosomal Targeting: A Novel Aspect to Be Investigated for Metformin Repurposing in Neurodegenerative Diseases?
- Aberrant HSF1 signaling activation underlies metformin amelioration of myocardial infarction in mice
- Metformin induces ZFP36 by mTORC1 inhibition in cervical cancer-derived cell lines
- Protein Interaction Network for Identifying Vascular Response of Metformin (Oral Antidiabetic)
- Preventing Long COVID With Metformin
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.