Effectiveness of GLP-1 Receptor Agonists in Patients With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomised Controlled Trials
Abstract
Polycystic ovary syndrome (PCOS) is a complex endocrine-metabolic disorder, and while metformin is widely used in its management, its efficacy remains variable. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as potential alternatives due to their metabolic benefits. In this systematic review, we have evaluated the effectiveness of GLP-1 RAs on body mass index (BMI), homeostatic model assessment of insulin resistance (HOMA-IR), and total testosterone (TT) in women with PCOS. Randomised controlled trials (RCTs) comparing the effect of GLP-1 RAs with metformin, standard, or placebo on BMI, HOMA-IR, and TT in women with PCOS were selected following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. A comprehensive literature search was conducted in various databases, including PubMed, Scopus, Embase, MEDLINE, Web of Science, Cochrane, and CINAHL through May 20, 2025. Eighteen RCTs comparing GLP-1 RAs with placebo, metformin, or standard therapy were included. Quality assessment was done using Cochrane's 'Risk of Bias tool (RoB2)'. Review Manager (RevMan) version 5.4.1 (The Cochrane Collaboration, London, United Kingdom) was used to perform random-effects meta-analysis. Continuous outcomes were pooled as mean differences (MD) when measured on the same scale and as standardised mean differences (SMD) when the scales differed, each with a 95% confidence interval (CI). Inter-study heterogeneity among the trials was…
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