Adverse Effects of the Common Treatments for Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

被引:89
作者
Domecq, Juan Pablo [1 ,2 ,8 ]
Prutsky, Gabriela [1 ,2 ,9 ]
Mullan, Rebecca J. [1 ,3 ]
Sundaresh, Vishnu [1 ,10 ]
Wang, Amy T. [1 ]
Erwin, Patricia J. [1 ]
Welt, Corrine [4 ]
Ehrmann, David [5 ]
Montori, Victor M. [1 ,2 ,6 ]
Murad, Mohammad Hassan [1 ,7 ]
机构
[1] Mayo Clin, Knowledge & Evaluat Res Unit, Rochester, MN 55905 USA
[2] Unidad Conocimiento & Evidencia, Lima, Peru
[3] Univ Minnesota, Sch Med, Minneapolis, MN 55455 USA
[4] Massachusetts Gen Hosp, Reprod Endocrine Unit, Boston, MA 02114 USA
[5] Univ Chicago, Endocrinol Sect, Chicago, IL 60637 USA
[6] Mayo Clin, Div Endocrinol, Rochester, MN 55905 USA
[7] Mayo Clin, Div Prevent Occupat & Aerosp Med, Rochester, MN 55905 USA
[8] Henry Ford Hosp, Dept Internal Med, Detroit, MI 48202 USA
[9] Wayne State Univ, Childrens Hosp Michigan, Dept Pediat, Sch Med,Detroit Med Ctr, Detroit, MI 48201 USA
[10] Louisiana State Univ, Hlth Sci Ctr, Div Endocrinol & Metab, Shreveport, LA 33932 USA
关键词
LIFE-STYLE MODIFICATION; LOW-DOSE FLUTAMIDE; ORAL-CONTRACEPTIVES; OBESE WOMEN; LONG-TERM; INSULIN-RESISTANCE; METFORMIN THERAPY; NONOBESE WOMEN; CARDIOVASCULAR RISK; HYPOCALORIC DIET;
D O I
10.1210/jc.2013-2374
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
Context: Polycystic ovary syndrome (PCOS) is common among women of childbearing age and the available pharmacological therapies have different side-effect profiles. Objective: We summarized the evidence about the side effects of oral contraceptive pills, metformin, and anti-androgens in women with PCOS. Data Source: Sources included Ovid Medline, OVID EMBASE, OVID Cochrane Library, Web of Science, Scopus, PsycInfo, and CINAHL from inception through April 2011. Study Selection: We included comparative observational studies enrolling women with PCOS who received the agents of choice for at least 6 months and reported adverse effects. Data Extraction: Using a standardized, piloted, and Web-based data extraction form and working in duplicate, we abstracted data from each study and performed meta-analysis when possible. Data Synthesis: We found 22 eligible studies of which 20 were randomized. No study reported severe side effects (eg, lactic acidosis, thromboembolic episodes, liver toxicity, cancer incidence, or pregnancy loss). Meta-analysis demonstrated no significant change in weight in oral contraceptive pills or flutamide users. Indirect evidence from populations without PCOS demonstrated no increased risk of lactic acidosis with metformin, only case reports of liver toxicity with flutamide (no comparative evidence), and increased relative risk difference of venous thromboembolism with oral contraceptive pills but very low absolute risk. Evidence on mortality, cardiovascular mortality, and cancer was inconclusive. Conclusions: Drugs commonly used to treat PCOS appear to be associated with very low risk of severe adverse effects although data are extrapolated from other populations.
引用
收藏
页码:4646 / 4654
页数:9
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