Insulin Sensitizers for the Treatment of Hirsutism: A Systematic Review and Metaanalyses of Randomized Controlled Trials
Abstract
CONTEXT: Insulin sensitizers, including metformin and thiazolidinediones (TZDs), improve hyperinsulinemia and reproductive dysfunctions in some women with hyperandrogenism. The extent to which these agents improve hirsutism remains unclear. OBJECTIVE: Our objective was to conduct a systematic review and metaanalyses of randomized controlled trials of metformin or TZDs for the treatment of hirsutism. DATA SOURCES: We searched the following databases: MEDLINE, EMBASE, and Cochrane CENTRAL (up to May 2006). Review of reference lists and contact with hirsutism experts further identified candidate trials. STUDY SELECTION: Reviewers working independently and in duplicate, with acceptable chance-adjusted agreement (kappa = 0.72), determined trial eligibility. Eligible trials randomly assigned women with hirsutism to at least 6 months of insulin sensitizers or control and measured hirsutism outcomes. DATA EXTRACTION: Reviewers working independently and in duplicate determined the methodological quality of trials and collected data on patient characteristics, interventions, and outcomes. DATA SYNTHESIS: Of 348 candidate studies, 16 trials (22 comparisons) were eligible. The methodological quality of these trials was low. Random-effects metaanalyses showed a small decrease in Ferriman-Gallwey scores in women treated with insulin sensitizers compared with placebo [pooled weighted mean difference (WMD) of -1.5; 95% confidence interval (CI), -2.8 to -0.2; inconsistency (I(2)) = 75%]. There was no significant difference between insulin sensitizers and oral contraceptives (WMD of -0.5; CI, -5.0, 3.9; I(2) = 79%). Metformin was inferior to both spironolactone (WMD of 1.3; CI, 0.03, 2.6) and flutamide (WMD of 5.0; CI, 3.0, 7.0; I(2) = 0%). CONCLUSIONS: Imprecise and inconsistent evidence of low to very low quality suggests that insulin sensitizers provide limited or no important benefit for women with hirsutism.
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Meta-analyses including larger number of RCTs in women with PCOS showed limited or no benefit of insulin sensitizers on hirsutism.
“Meta-analyses including larger number of RCTs in women with PCOS showed limited or no benefit of insulin sensitizers on hirsutism [185, 186].”
From Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls (2019) · cites this paper as [185]
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- Authors
- Cosma, M., Swiglo, B. A., Flynn, D. N., Kurtz, D. M., LaBella, M. L., Mullan, R. J., Elamin, M. B., Erwin, P. J., & Montori, V. M.
- Affiliations
- Mayo Clinic (US)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2008-04
- Volume
- 93
- Issue
- 4
- Pages
- 1135-1142
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2103374510
- Cited by
- 129
- References
- 36
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 4 · 2022: 4 · 2021: 5 · 2020: 3 · 2019: 5 · 2018: 7 · 2017: 10 · 2016: 11 · 2015: 9 · 2014: 12 · 2013: 13 · 2012: 8
- FWCI
- 1.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Dermatology › Acne and Rosacea Treatments and Effects
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- hirsutism, insulin sensitizers, metformin, thiazolidinediones, hyperandrogenism, Ferriman-Gallwey score, oral contraceptives, spironolactone, flutamide, treatment efficacy
- MeSH terms
- Androgen Antagonists, Drug Therapy, Combination, Hirsutism, Humans, Hypoglycemic Agents, Metformin, Randomized Controlled Trials as Topic
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