PIOGLITAZONE: A NEW PARADIGM IN MANAGEMENT OF PCOS; AN OPEN LABELLED STUDY

Background: Met formin and spironolactone have been used extensively for treatment of polycystic ovary syndrome (PCOS)but pioglitazone still lacks sufficient evidence-based support to be recommended in standard guidelines. Aims We compared effects of pioglitazone in combination with either metformin or spironolactone in 50 PCOS females on clinical, metabolic and hormonal parameters.

Design: Prospective non-randomised open label study among women with PCOS at a tertiary care endocrine clinic.

Methods: Women (n=50) diagnosed with PCOS were categorised into two groups with group I treated with 15 mg pioglitazone and 50 mg spironolactone, group II treated with 15 mg pioglitazone and 1000 mg metformin. Various clinical, metabolic, hormonal parameters, insulin sensitivity markers like HOMA-IR, QUICKI and serum resisting, adiponectin were assessed at baseline and after six months. Results Both groups showed significant improvement in number of menstrual cycles per year and Ferriman Gallwey (FG)score after six months. Serum total cholesterol, 2-hour plasma glucose post OGTT and HOMA-IR showed nonsignificant downward trend in both groups. Serum total testosterone also declined significantly in either group with nonsignificant superior trend observed in group II in comparison of group I (48% vs 31%).Serum adiponectin levels increased significantly in both groupsdespite increase in BMI and waist circumference. No major adverse events noted in either group. ConclusionsThusaddition of pioglitazone to spironolactone or metformin in PCOS women improves overall metabolic milieu and underlying insulin resistance despite increase in BMI.Randomized trials with longer duration of treatmentare warranted to better evaluate effects of this combination therapy.