Metformin or Oral Contraceptives for Adolescents With Polycystic Ovarian Syndrome: A Meta-analysis

• Published in: Pediatrics (Evanston) 2016-05, Vol.137 (5), p.1-1
• Main Authors: Al Khalifah, Reem A, Florez, Ivan D, Dennis, Brittany, Thabane, Lehana, Bassilious, Ereny
• Format: Article
• Language: English
• Subjects: Acne Vulgaris - drug therapy; Adolescent; Analysis; Birth control; Body Mass Index; Care and treatment; Confidence intervals; Contraceptives, Oral - adverse effects; Contraceptives, Oral - therapeutic use; Dosage and administration; Female; Glucose Metabolism Disorders - drug therapy; Health aspects; Hirsutism - drug therapy; Humans; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Lipids - blood; Menstruation Disturbances - drug therapy; Meta-analysis; Metformin; Metformin - adverse effects; Metformin - therapeutic use; Oral contraceptives; Pediatrics; Polycystic ovary syndrome; Polycystic Ovary Syndrome - blood; Polycystic Ovary Syndrome - complications; Polycystic Ovary Syndrome - drug therapy; Stein-Leventhal syndrome; Teenagers; Young Adult; Youth
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2015-4089

Polycystic ovarian syndrome (PCOS) is a common disease. There is limited evidence to support various treatment choices. This leads to variable treatment practices. To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the use of metformin versus oral contraceptive pills (OCPs) for the treatment of PCOS in adolescents aged 11 to 19 years. We performed literature searches through Ovid Medline, Ovid Embase, Cochrane Central Register of Controlled Trials, and gray literature resources, up to January 29, 2015. Two reviewers screened titles and abstracts of identified citations, assessed full text eligibility, and extracted information from eligible trials. Four RCTs met the inclusion and exclusion criteria. The reviewed evidence came from 170 patients. Overall, OCP treatment resulted in modest improvement in menstrual cycle frequency (weighted mean difference [WMD] = 0.27, P < .01, 95% confidence interval [CI] -0.33 to -0.21) and mild reduction of acne scores (WMD = 0.3, P = .02, 95% CI 0.05 to 0.55). While metformin resulted in greater BMI reduction (WMD = -4.02, P < .01, 95% CI -5.23 to -2.81) it was associated with decreased dysglycemia prevalence (risk ratio: 0.41, P = .02, 95% CI 0.19 to 0.86) and improved total cholesterol and low-density lipoprotein levels. Metformin and OCPs were similar in terms of impact on hirsutism. Current evidence is derived from very low to low quality evidence. Therefore, treatment choice should be guided by patient values and preferences while balancing potential side effects. Future high quality RCTs are needed to address several questions for the treatment of adolescents with PCOS.