Diabetology & Metabolic Syndrome, Journal Year: 2025, Volume and Issue: 17(1)
Published: May 24, 2025
Polycystic ovary syndrome (PCOS) is a complex endocrine characterized by hyperandrogenism, hormonal imbalances, and metabolic disruptions, leading to reproductive complications increased risk of cardiometabolic diseases. While lifestyle modifications are the cornerstone PCOS management, pharmacological interventions, including metformin, oral contraceptives, anti-androgens, commonly utilized. Recently, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) sodium-glucose cotransporter-2 inhibitors (SGLT2is) have shown promising results in management. This study conducted comprehensive review randomized clinical trials evaluating effects GLP-1 RAs SGLT2is women with PCOS. A systematic literature search was performed, network meta-analysis using random-effects model that generated mixed treatment comparison estimates employed assess comparative efficacy these drug classes on (menstrual frequency, pregnancy rate proportion patients regular menstrual cycles), anthropometric, hormonal, parameters. Additionally, preclinical studies investigating animal models undertaken. included 27 RCTs (1642 participants). (alone combination metformin) were observed improve frequencies. showed significant reductions all anthropometric parameters, while wait hip ratio (WHR) android gynoid fat (AGF) (in addition reduced body weight SGLT2is/metformin combination). Reductions WHR AGF better compared RAs. The superior reducing weight, percent mass, alone. Regarding improvement free androgen index (FAI), testosterone, androstenedione, sex hormone binding globulin levels. improvements FAI total outperforming significantly improved triglycerides, markers insulin resistance fasting postprandial plasma glucose. associated homeostatic assessment for (HOMA-IR) glucose, triglycerides. outperformed LDL cholesterol HOMA-IR. than triglycerides However, strength evidence findings very low. Systematic revealed potential association several molecular pathways, AMPK-α, SIRT1, FDX, PI3K/AKT, endothelial adhesion molecules (VCAM, ICAM, E-selectin), STAR, CYP17A1, therapeutic Both ovarian morphology studies. advance our understanding both demonstrate their distinct mechanisms offer unique advantages. excel improving profiles resistance, whereas show consistent benefits enhanced therapy suggests paradigm shift strategies, moving beyond traditional monotherapy approaches. These support classes, individually or combined, providing foundation more personalized
Language: Английский