Predictors of the efficacy of metformin in polycystic ovary syndrome
Objective. To identify possible clinical, endocrine, and metabolic predictors for the efficiency of metformin therapy for polycystic ovary syndrome (PCOS).Naidukova A.A., Ananyev E.V., Donnikov A.E., Chernukha G.E.
Subjects and methods. The investigation enrolled 143 women (mean age, 26.4±4.6 years; mean body mass index, 23.8±4.8 kg/m2) with PCOS. All the patients were treated with metformin 1500 mg/day for 6 months. All the study participants were divided into two groups: 1) 70 (53.1%) patients with a complete response to therapy; 2) 48 (36.3%) patients unresponsive to metformin therapy. 14 (10.6%) patients with a partial response to therapy were excluded from analysis. A comprehensive examination, including pelvic organ ultrasonography, determination of the serum levels of androgens, anti-Müllerian hormone (AMH), luteinizing hormone (LH), and follicle-stimulating hormone, and a two-hour glucose tolerance test was carried out to estimate the concentrations of glucose and insulin at baseline and after 6 months of therapy.
Results. The comparative analysis revealed the higher levels of AMH, total testosterone (TT), and the A/G index in the nonresponse group. The levels of AMH of less than 13.3 ng/ml, TT of 1.81 ng/ml, and A/G index of less than 0.9 can be considered prognostically favorable. After 6 months of metformin therapy, there were decreases in the level of androgens in Group 1 (p < 0.05) and in that of AMH in both groups.
Conclusion. Comprehensive examination, including the assessment of the hormonal profile and body composition, is indicated before metformin therapy for PCOS. Metformin therapy responses can be predicted, by estimating the serum levels of TT, AMH, and A/G index, which allows optimization of management tactics for patients with PCOS.
Keywords
polycystic ovary syndrome
therapeutic effectiveness
metformin
Supplementary Materials
- Table 1. Clinical characteristics in groups with menstrual period restoration and with absence of metformin effect.
- Table 2. ROC-analyses: hormonal and dual-energy X-ray absorptiometry characteristics significance in prediction metformin effectiveness.
- Table 3. Metformin therapy: dynamic of hormonal, metabolic and body composition characteristics.
- Fig.1.ROC-analyses of dependence of menstrual period restoration on: a) AMH and total testosterone levels; b) dual-energy X-ray absorptiometry; c) Index A/G distribution depending metformin effectiveness (0 – absence of effect, 1- menstrual period restoration).
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Received 08.09.2017
Accepted 22.09.2017
About the Authors
Naidukova A.A., post-graduate student, Department of Gynecological Endocrinology, Research Center of Obstetrics, Gynecology and Perinatology,Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79166750097. E-mail: aleeshka@mail.ru
Ananyev E.V., head of the 2nd maternity ward, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79857679777. E-mail: new_vision@mail.ru
Donnikov Andrey Evgenyevich, PhD, senior staff scientist of laboratory of molecular genetic methods, Research Center of Obstetrics, Gynecology, and Perinatology,
Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954381341. E-mail: a_donnikov@oparina4.ru
Chernukha G.E., head of the Department of Gynecological Endocrinology, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79859996000. E-mail: c-galina1@yandex.ru
For citations: Naidukova A.A., Ananyev E.V., Donnikov A.E., Chernukha G.E. Predictors of the efficacy of metformin in polycystic ovary syndrome. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (11): 69-76. (in Russian)
https://dx.doi.org/10.18565/aig.2017.11.69-76
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