Liraglutide plus Metformin versus Metformin alone in women living with Polyendocrine metabolic ovarian syndrome (PMOS): A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Background: Polyendocrine metabolic ovarian syndrome (PMOS), formerly referred to as polycystic ovary syndrome (PCOS), is among the most common endocrine disorders in women of reproductive age. Methods: An extensive literature search was done on Cochrane, PubMed, TRIP and Google Scholar. Pooled effect estimates were calculated using a fixed-effect model (I2<0 %) and a random-effects model was applied (I2>50 %). Result: The combination of metformin and liraglutide was associated with significantly lower fasting blood glucose level as compared to mono-therapy [MD]= -0.19 mmol/L, 95% CI: -0.33-0.06 mmol/l, Z=2.79, P=0.005, χ²=6.08, df=3, P=0.11, I2=0%). The combination of drugs significantly increased sex hormone binding globulin as compared to monotherapy [MD]= 7.89L, 95% CI 3.80-11.99, Z=3.78, P=0.0002, χ²=1.74, df=1, P=0.19, I2=42%). The pooled analysis demonstrated that metformin significantly reduced the risk of nausea as compared to the Metformin and liraglutide combination (RR=8.30 95% CI: 2.64, 26.10, Z=3.62, P=0.0003, χ²=0.43, df=2, p=0.80, I2 =0%). Conclusion: The combination of liraglutide and metformin was found to be advantageous over metformin in monotherapy, with respect to improving the patient’s glycaemic control by inducing a significant reduction in the fasting blood glucose level as compared to monotherapy. The combination therapy also significantly increased sex hormone binding globulin, such hormonal control is an underpinning facet in the treatment of PMOS and therefore this finding advocates for the use of metformin and liraglutide in combination.