Comparative analysis of glucagon-like peptide-1 receptor agonists, metformin, and inositol in improving anthropometric and metabolic outcomes in women with polycystic ovary syndrome: a network meta-analysis
Abstract
Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder characterized by obesity, insulin resistance, and cardiometabolic risks. Lifestyle intervention is first-line therapy, but drug therapy is often necessary. Common treatments include metformin, myoinositol, and glucagon-like peptide-1 (GLP-1) receptor agonists. The comparative metabolic efficacy of these treatments remains unclear.
Methods: We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) according to PRISMA-NMA guidelines. Eligible studies recruited non-menopausal women with PCOS and evaluated GLP-1 receptor agonists, metformin, or myoinositol (± folic acid [FA]) alone or in combination versus placebo or active comparators. The primary outcome was body weight change, while secondary outcomes included body mass index (BMI), waist circumference, and Homeostasis Model Assessment for Insulin Resistance (HOMA-IR). Outcomes were synthesized using a frequentist random-effects NMA, and the CINeMA framework was used to assess certainty.
Results: Sixteen RCTs were included. GLP-1 + metformin was the most effective intervention for weight reduction (MD -5.58 kg; 95% CI -8.57 to -2.59) and BMI decrease (MD -2.17; 95% CI -2.77 to -1.58). GLP-1 monotherapy also showed decreases in weight (MD -5.22 kg) and BMI (MD -2.00). Waist circumference was significantly reduced by GLP-1 alone (MD -4.70 cm). None ofthe interventions showed significant effects on HOMA-IR,…
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