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Pharmacotherapy effective weight-loss option in PCOS with obesity
The GLP-1 receptor agonist liraglutide, the weight loss drug orlistat and metformin are effective adjuncts to a low-energy diet and increased physical activity for women with polycystic ovary syndrome and overweight or obesity, according to a meta-analysis published in Obesity Reviews.
“Although lifestyle management is the first-line therapy in PCOS for prevention of weight gain and for weight loss, the efficacy of lifestyle management for established obesity has been limited in PCOS in the general population and new approaches are needed,” Fangfang Wang, of Zhejiang University School of Medicine in Hangzhou, China, and colleagues wrote in the study background. “Moreover, for some woman with PCOS and obesity, lifestyle modifications are not effective, or for the women who cannot or are not willing to modify their lifestyle, the pharmacologic therapy to induce weight loss is also very important.”
Wang and colleagues analyzed data from 23 trials including 941 women or adolescent girls diagnosed with PCOS and overweight or obesity, recruited from outpatient clinics, hospitals or medical centers. Included studies had a randomized, parallel-group trial design and included placebo or metformin as a control arm. Researchers conducted a network meta-analysis to simultaneously compare the efficacy of different treatment options for managing weight (BMI and absolute weight change) and waist circumference (absolute waist change).
Apart from four trials examining a combination of liraglutide plus metformin (n = 60), included studies examined single-drug interventions, including liraglutide (6 studies; Saxenda, Novo Nordisk), metformin (19 studies), orlistat (5 studies; Alli, GlaxoSmithKline; Xenical, Roche) and placebo (14 studies).
Compared with placebo, all interventions were associated with a reduction in BMI in women with PCOS and overweight or obesity; however, in subgroup analysis, only orlistat reduced BMI after 12 weeks, according to researchers. Treatment with metformin was not associated with a reduction in BMI at 24 weeks.
Similarly, all interventions were associated with a decrease in weight vs. placebo; however, the magnitude of the weight reduction differed by therapy. Researchers observed the greatest weight loss in women assigned liraglutide, followed by orlistat and metformin monotherapy. Liraglutide alone was more effective regarding weight loss vs. liraglutide plus metformin therapy, according to researchers.
At 12 weeks, researchers observed a reduction in BMI for women assigned orlistat therapy only, whereas liraglutide alone and orlistat were associated with reductions in weight at 12 weeks. Researchers observed that metformin was superior to placebo for weight loss at 24 weeks.
Results for waist circumference were consistent with results for BMI and weight loss across therapies, according to researchers.
The researchers noted that a hypocaloric diet and physical activity remain first-line treatments for weight loss in women with PCOS. Aerobic physical activity of moderate intensity for 90 minutes is recommended for women with PCOS, whereas 5% to 15% weight loss is recommended to improve clinical symptoms.
“However, lifestyle interventions seem not to be effective in providing lasting weight loss success,” the researchers wrote. “In addition, there is heterogeneity in the responsiveness to long-term lifestyle intervention in women with overweight/obesity and PCOS. Thus, more aggressive treatments, such as weight-loss medication, should be added to patients who fail to respond to lifestyle intervention.” – by Regina Schaffer
Disclosure: The authors report no relevant financial disclosures.