Item #7
Safety
and Efficacy of Metformin for PCOS is Still in Question
A
leading British expert says caution is still needed as solid evidence
about its efficacy is sparse.
The insulin
sensitising agent metformin has attracted a lot of attention as a
treatment for polycystic ovary syndrome (PCOS) in recent years, but
beware.
PCOS
prevalence is increasing in the Western world, partly in tandem with
increasing BMI and rates of insulin resistance, Dr. Adam Balen from
the General Infirmary at Leeds said at a joint meeting of the Royal
College of Obstetricians and Gynaecologists and the British Fertility
Society.
Currently
about 20% of couples seeking fertility treatment do so due to
anovulation, and 85%-90% of those have PCOS. Metformin, which inhibits
the production of hepatic glucose and increases the sensitivity of
peripheral tissue to insulin, has garnered a lot of publicity as a
treatment, but scientifically sound data is inadequate, says Dr.
Balen.
There's
a huge amount of buzz around the drug and patients are asking to be
prescribed it, but "all that's come out of small studies,"
he said. Adequately powered clinical studies are lacking, while
"there are other treatments for anovulatory infertility that have
gone through the mill and the evidence is strong."
For
patients who have been appropriately investigated by a reproductive
physician, Dr. Balen is sure there is a role for metformin in women
with PCOS.
"I
think the good thing about metformin is that it has been around for a
long time in the treatment of diabetes and appears to be a safe drug.
Also, in the context of women wanting to get pregnant there doesn't
seem to be an increased risk to the foetus," he said. "But
again, we need to have appropriately published evidence."
In
an effort to fill in some of the research blanks, Dr. Balen and
colleagues are conducting a randomized, placebo-controlled trial in
260 women, about 170 of whom have so far been recruited.
They
are including women who have a BMI over 30, PCOS and irregular
periods. The women take the drug or placebo for 6 months, and are
given advice on diet and exercise.
"Metformin
is also often projected as a drug that will help women to lose weight
but there is no clear evidence that it helps lose weight," Dr.
Balen added. "Many women will lose weight while taking metformin
because they've also been given advice on diet and exercise at the
same time."
The
results of the trial are expected in about a year.
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