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Clinical review: Insulin sensitizers for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials.
J Clin Endocrinol Metab. 2008 Apr; 93(4):1135-42.JC

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.

Authors+Show Affiliations

Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

18252787

Citation

Cosma, Mihaela, et al. "Clinical Review: Insulin Sensitizers for the Treatment of Hirsutism: a Systematic Review and Metaanalyses of Randomized Controlled Trials." The Journal of Clinical Endocrinology and Metabolism, vol. 93, no. 4, 2008, pp. 1135-42.
Cosma M, Swiglo BA, Flynn DN, et al. Clinical review: Insulin sensitizers for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials. J Clin Endocrinol Metab. 2008;93(4):1135-42.
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. (2008). Clinical review: Insulin sensitizers for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials. The Journal of Clinical Endocrinology and Metabolism, 93(4), 1135-42. https://doi.org/10.1210/jc.2007-2429
Cosma M, et al. Clinical Review: Insulin Sensitizers for the Treatment of Hirsutism: a Systematic Review and Metaanalyses of Randomized Controlled Trials. J Clin Endocrinol Metab. 2008;93(4):1135-42. PubMed PMID: 18252787.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical review: Insulin sensitizers for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials. AU - Cosma,Mihaela, AU - Swiglo,Brian A, AU - Flynn,David N, AU - Kurtz,David M, AU - Labella,Matthew L, AU - Mullan,Rebecca J, AU - Elamin,Mohamed B, AU - Erwin,Patricia J, AU - Montori,Victor M, Y1 - 2008/02/05/ PY - 2008/2/7/pubmed PY - 2008/5/28/medline PY - 2008/2/7/entrez SP - 1135 EP - 42 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 93 IS - 4 N2 - 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. SN - 0021-972X UR - https://www.unboundmedicine.com/medline/citation/18252787/Clinical_review:_Insulin_sensitizers_for_the_treatment_of_hirsutism:_a_systematic_review_and_metaanalyses_of_randomized_controlled_trials_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2007-2429 DB - PRIME DP - Unbound Medicine ER -