Effects of GLP-1 Receptor Agonists vs Metformin in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis
Abstract
Polycystic ovarian syndrome (PCOS) is a common endocrine disorder associated with significant metabolic and reproductive dysfunction. Although metformin has long been a cornerstone of PCOS management, glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have emerged as promising alternatives, particularly for improving metabolic outcomes. This systematic review and meta-analysis aimed to evaluate the effects of GLP-1 RAs compared with metformin on metabolic, hormonal, and reproductive parameters in women with PCOS. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, randomized controlled trials (RCTs) comparing GLP-1 RAs with metformin in women diagnosed with PCOS were systematically identified and analyzed. Four eligible RCTs comprising a total of 218 participants were included. Statistical analyses were conducted using a fixed-effects model. Compared with metformin, GLP-1 RAs were associated with significant reductions in serum testosterone (standardized mean difference (SMD) = -0.327, p = 0.036), dehydroepiandrosterone sulfate (DHEA-S) (SMD = -0.528, p = 0.048), androstenedione (SMD = -0.523, p = 0.002), and insulin resistance as assessed by the homeostasis model assessment of insulin resistance (HOMA-IR) (SMD = 1.217, p < 0.001). However, substantial heterogeneity across studies and potential publication bias were observed. Overall, GLP-1 RAs were associated with favorable improvements in key hormonal and metabolic…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 218 participants or records.
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