The comparative effectiveness of 55 interventions in obese patients with polycystic ovary syndrome: A network meta-analysis of 101 randomized trials
Polycystic ovary syndrome (PCOS) affects up to 18% of reproductive-age females. The prevalence of obesity in PCOS patients reaches up to 80%, which is 2-fold higher than the general population. The present study aimed to compare the effectiveness of 55 pharmacological interventions across 17 differe...
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| Veröffentlicht in: | PloS one 2021-07, Vol.16 (7), p.e0254412 |
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| creator | Abdel-Maboud, Mohamed Menshawy, Amr Hasabo, Elfatih A Abdelraoof, Mohamed Ibrahim Alshandidy, Mohamed Eid, Muhammad Menshawy, Esraa Outani, Oumaima Menshawy, Ahmed |
| description | Polycystic ovary syndrome (PCOS) affects up to 18% of reproductive-age females. The prevalence of obesity in PCOS patients reaches up to 80%, which is 2-fold higher than the general population. The present study aimed to compare the effectiveness of 55 pharmacological interventions across 17 different outcomes in overweight/obese PCOS patients with hyperandrogenism manifestations for both short- and long-term follow-ups. A comprehensive literature search was performed on PubMed, Scopus, Embase, Science Direct, Web of Science, and Cochrane CENTRAL for randomized controlled trials comparing any conventional pharmacological intervention as a monotherapy or a combination in overweight/obese patients with polycystic ovary syndrome and hyperandrogenism manifestations. Extracted data included three main parameters; I. Anthropometric parameters (BMI, Waist and Hip circumferences, and Waist/HIP ratio), II. Hormonal parameters (FSH, LH, FSG, SHBG, Estradiol, Total Testosterone, Free testosterone, DHEAS, Androstenedione), and III. Metabolic parameters (Total Cholesterol, LDL-C, HDL-C, Triglycerides, Fasting glucose, Fasting glucose, HOMA-IR). Critical appraisal and risk of bias assessments were performed using the modified Jadad scale, and the overall quality of this network meta-analysis was evaluated according to the CINeMA framework. We performed both a pairwise meta-analysis and a network meta-analysis to evaluate the effect sizes with 95% CI, and we calculated the surface under the cumulative ranking curve (SUCRA) for each intervention. Our final search on May 15.sup.th 2021 retrieved 23,305 unique citations from searching six electronic databases. Eventually, 101 RCTs of 108 reports with a total of 8,765 patients were included in our systematic review and multi-treatments meta-analysis. 55 different interventions were included: 22 monotherapies, and 33 combinations. The two-dimensional cluster ranking of the average SUCRA values for metabolic and hormonal parameters with significant estimates revealed flutamide (77.5%, 70%; respectively) as the highest and rosiglitazone (38.2%, 26.3%; respectively) as the lowest, in terms of the overall efficacy in reducing weight and hyperandrogenism. However, cyproterone-acetate+ethinylestradiol exhibited a higher ranking in improving hormonal parameters (71.1%), but even a lower-ranking regarding metabolic parameters (34.5%). Current evidence demonstrated the superiority of flutamide in improving both metabolic and hormonal |
| doi_str_mv | 10.1371/journal.pone.0254412 |
| format | Article |
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The prevalence of obesity in PCOS patients reaches up to 80%, which is 2-fold higher than the general population. The present study aimed to compare the effectiveness of 55 pharmacological interventions across 17 different outcomes in overweight/obese PCOS patients with hyperandrogenism manifestations for both short- and long-term follow-ups. A comprehensive literature search was performed on PubMed, Scopus, Embase, Science Direct, Web of Science, and Cochrane CENTRAL for randomized controlled trials comparing any conventional pharmacological intervention as a monotherapy or a combination in overweight/obese patients with polycystic ovary syndrome and hyperandrogenism manifestations. Extracted data included three main parameters; I. Anthropometric parameters (BMI, Waist and Hip circumferences, and Waist/HIP ratio), II. Hormonal parameters (FSH, LH, FSG, SHBG, Estradiol, Total Testosterone, Free testosterone, DHEAS, Androstenedione), and III. Metabolic parameters (Total Cholesterol, LDL-C, HDL-C, Triglycerides, Fasting glucose, Fasting glucose, HOMA-IR). Critical appraisal and risk of bias assessments were performed using the modified Jadad scale, and the overall quality of this network meta-analysis was evaluated according to the CINeMA framework. We performed both a pairwise meta-analysis and a network meta-analysis to evaluate the effect sizes with 95% CI, and we calculated the surface under the cumulative ranking curve (SUCRA) for each intervention. Our final search on May 15.sup.th 2021 retrieved 23,305 unique citations from searching six electronic databases. Eventually, 101 RCTs of 108 reports with a total of 8,765 patients were included in our systematic review and multi-treatments meta-analysis. 55 different interventions were included: 22 monotherapies, and 33 combinations. The two-dimensional cluster ranking of the average SUCRA values for metabolic and hormonal parameters with significant estimates revealed flutamide (77.5%, 70%; respectively) as the highest and rosiglitazone (38.2%, 26.3%; respectively) as the lowest, in terms of the overall efficacy in reducing weight and hyperandrogenism. However, cyproterone-acetate+ethinylestradiol exhibited a higher ranking in improving hormonal parameters (71.1%), but even a lower-ranking regarding metabolic parameters (34.5%). Current evidence demonstrated the superiority of flutamide in improving both metabolic and hormonal parameters, and the higher efficacy of cyproterone-acetate+ethinylestradiol only in improving hormonal parameters. Nearly all interventions were comparable in female hormones, FGS, HDL, glucose, and insulin levels improvements.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0254412</identifier><identifier>PMID: 34280195</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>17β-Estradiol ; Acetic acid ; Amenorrhea ; Androgens ; Androstenedione ; Biology and Life Sciences ; Birth control ; Body weight ; Care and treatment ; Cholesterol ; Clinical trials ; Effectiveness ; Ethinylestradiol ; Evaluation ; Fasting ; Flutamide ; Follicle-stimulating hormone ; Glucose ; High density lipoprotein ; Hormones ; Infertility ; Insulin ; Insulin resistance ; Intervention ; Laboratory testing ; Low density lipoprotein ; Luteinizing hormone ; Medicine ; Medicine and Health Sciences ; Menstruation ; Meta-analysis ; Metabolism ; Obesity ; Ovaries ; Overweight ; Parameter estimation ; People and places ; Performance evaluation ; Pharmacology ; Physical Sciences ; Polycystic ovary syndrome ; Population studies ; Ranking ; Research and Analysis Methods ; Rosiglitazone ; Sex hormones ; Stein-Leventhal syndrome ; Systematic review ; Testosterone ; Triglycerides ; Weight reduction</subject><ispartof>PloS one, 2021-07, Vol.16 (7), p.e0254412</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Abdel-Maboud et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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The prevalence of obesity in PCOS patients reaches up to 80%, which is 2-fold higher than the general population. The present study aimed to compare the effectiveness of 55 pharmacological interventions across 17 different outcomes in overweight/obese PCOS patients with hyperandrogenism manifestations for both short- and long-term follow-ups. A comprehensive literature search was performed on PubMed, Scopus, Embase, Science Direct, Web of Science, and Cochrane CENTRAL for randomized controlled trials comparing any conventional pharmacological intervention as a monotherapy or a combination in overweight/obese patients with polycystic ovary syndrome and hyperandrogenism manifestations. Extracted data included three main parameters; I. Anthropometric parameters (BMI, Waist and Hip circumferences, and Waist/HIP ratio), II. Hormonal parameters (FSH, LH, FSG, SHBG, Estradiol, Total Testosterone, Free testosterone, DHEAS, Androstenedione), and III. Metabolic parameters (Total Cholesterol, LDL-C, HDL-C, Triglycerides, Fasting glucose, Fasting glucose, HOMA-IR). Critical appraisal and risk of bias assessments were performed using the modified Jadad scale, and the overall quality of this network meta-analysis was evaluated according to the CINeMA framework. We performed both a pairwise meta-analysis and a network meta-analysis to evaluate the effect sizes with 95% CI, and we calculated the surface under the cumulative ranking curve (SUCRA) for each intervention. Our final search on May 15.sup.th 2021 retrieved 23,305 unique citations from searching six electronic databases. Eventually, 101 RCTs of 108 reports with a total of 8,765 patients were included in our systematic review and multi-treatments meta-analysis. 55 different interventions were included: 22 monotherapies, and 33 combinations. The two-dimensional cluster ranking of the average SUCRA values for metabolic and hormonal parameters with significant estimates revealed flutamide (77.5%, 70%; respectively) as the highest and rosiglitazone (38.2%, 26.3%; respectively) as the lowest, in terms of the overall efficacy in reducing weight and hyperandrogenism. However, cyproterone-acetate+ethinylestradiol exhibited a higher ranking in improving hormonal parameters (71.1%), but even a lower-ranking regarding metabolic parameters (34.5%). Current evidence demonstrated the superiority of flutamide in improving both metabolic and hormonal parameters, and the higher efficacy of cyproterone-acetate+ethinylestradiol only in improving hormonal parameters. Nearly all interventions were comparable in female hormones, FGS, HDL, glucose, and insulin levels improvements.</description><subject>17β-Estradiol</subject><subject>Acetic acid</subject><subject>Amenorrhea</subject><subject>Androgens</subject><subject>Androstenedione</subject><subject>Biology and Life Sciences</subject><subject>Birth control</subject><subject>Body weight</subject><subject>Care and treatment</subject><subject>Cholesterol</subject><subject>Clinical trials</subject><subject>Effectiveness</subject><subject>Ethinylestradiol</subject><subject>Evaluation</subject><subject>Fasting</subject><subject>Flutamide</subject><subject>Follicle-stimulating hormone</subject><subject>Glucose</subject><subject>High density lipoprotein</subject><subject>Hormones</subject><subject>Infertility</subject><subject>Insulin</subject><subject>Insulin resistance</subject><subject>Intervention</subject><subject>Laboratory testing</subject><subject>Low density lipoprotein</subject><subject>Luteinizing hormone</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Menstruation</subject><subject>Meta-analysis</subject><subject>Metabolism</subject><subject>Obesity</subject><subject>Ovaries</subject><subject>Overweight</subject><subject>Parameter estimation</subject><subject>People and places</subject><subject>Performance evaluation</subject><subject>Pharmacology</subject><subject>Physical Sciences</subject><subject>Polycystic ovary syndrome</subject><subject>Population studies</subject><subject>Ranking</subject><subject>Research and Analysis Methods</subject><subject>Rosiglitazone</subject><subject>Sex hormones</subject><subject>Stein-Leventhal syndrome</subject><subject>Systematic review</subject><subject>Testosterone</subject><subject>Triglycerides</subject><subject>Weight 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comparative effectiveness of 55 interventions in obese patients with polycystic ovary syndrome: A network meta-analysis of 101 randomized trials</title><author>Abdel-Maboud, Mohamed ; Menshawy, Amr ; Hasabo, Elfatih A ; Abdelraoof, Mohamed Ibrahim ; Alshandidy, Mohamed ; Eid, Muhammad ; Menshawy, Esraa ; Outani, Oumaima ; Menshawy, Ahmed</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c669t-f7cbd03453be990aefea187cca0ad4a9a8e2d9b314c149f13d5c24b46b670f0c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>17β-Estradiol</topic><topic>Acetic acid</topic><topic>Amenorrhea</topic><topic>Androgens</topic><topic>Androstenedione</topic><topic>Biology and Life Sciences</topic><topic>Birth control</topic><topic>Body weight</topic><topic>Care and treatment</topic><topic>Cholesterol</topic><topic>Clinical 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Collection</collection><collection>Genetics Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abdel-Maboud, Mohamed</au><au>Menshawy, Amr</au><au>Hasabo, Elfatih A</au><au>Abdelraoof, Mohamed Ibrahim</au><au>Alshandidy, Mohamed</au><au>Eid, Muhammad</au><au>Menshawy, Esraa</au><au>Outani, Oumaima</au><au>Menshawy, Ahmed</au><au>Atkin, Stephen L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The comparative effectiveness of 55 interventions in obese patients with polycystic ovary syndrome: A network meta-analysis of 101 randomized trials</atitle><jtitle>PloS one</jtitle><date>2021-07-19</date><risdate>2021</risdate><volume>16</volume><issue>7</issue><spage>e0254412</spage><pages>e0254412-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Polycystic ovary syndrome (PCOS) affects up to 18% of reproductive-age females. The prevalence of obesity in PCOS patients reaches up to 80%, which is 2-fold higher than the general population. The present study aimed to compare the effectiveness of 55 pharmacological interventions across 17 different outcomes in overweight/obese PCOS patients with hyperandrogenism manifestations for both short- and long-term follow-ups. A comprehensive literature search was performed on PubMed, Scopus, Embase, Science Direct, Web of Science, and Cochrane CENTRAL for randomized controlled trials comparing any conventional pharmacological intervention as a monotherapy or a combination in overweight/obese patients with polycystic ovary syndrome and hyperandrogenism manifestations. Extracted data included three main parameters; I. Anthropometric parameters (BMI, Waist and Hip circumferences, and Waist/HIP ratio), II. Hormonal parameters (FSH, LH, FSG, SHBG, Estradiol, Total Testosterone, Free testosterone, DHEAS, Androstenedione), and III. Metabolic parameters (Total Cholesterol, LDL-C, HDL-C, Triglycerides, Fasting glucose, Fasting glucose, HOMA-IR). Critical appraisal and risk of bias assessments were performed using the modified Jadad scale, and the overall quality of this network meta-analysis was evaluated according to the CINeMA framework. We performed both a pairwise meta-analysis and a network meta-analysis to evaluate the effect sizes with 95% CI, and we calculated the surface under the cumulative ranking curve (SUCRA) for each intervention. Our final search on May 15.sup.th 2021 retrieved 23,305 unique citations from searching six electronic databases. Eventually, 101 RCTs of 108 reports with a total of 8,765 patients were included in our systematic review and multi-treatments meta-analysis. 55 different interventions were included: 22 monotherapies, and 33 combinations. The two-dimensional cluster ranking of the average SUCRA values for metabolic and hormonal parameters with significant estimates revealed flutamide (77.5%, 70%; respectively) as the highest and rosiglitazone (38.2%, 26.3%; respectively) as the lowest, in terms of the overall efficacy in reducing weight and hyperandrogenism. However, cyproterone-acetate+ethinylestradiol exhibited a higher ranking in improving hormonal parameters (71.1%), but even a lower-ranking regarding metabolic parameters (34.5%). Current evidence demonstrated the superiority of flutamide in improving both metabolic and hormonal parameters, and the higher efficacy of cyproterone-acetate+ethinylestradiol only in improving hormonal parameters. Nearly all interventions were comparable in female hormones, FGS, HDL, glucose, and insulin levels improvements.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>34280195</pmid><doi>10.1371/journal.pone.0254412</doi><tpages>e0254412</tpages><orcidid>https://orcid.org/0000-0002-7746-524X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-07, Vol.16 (7), p.e0254412 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2553216393 |
| source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | 17β-Estradiol Acetic acid Amenorrhea Androgens Androstenedione Biology and Life Sciences Birth control Body weight Care and treatment Cholesterol Clinical trials Effectiveness Ethinylestradiol Evaluation Fasting Flutamide Follicle-stimulating hormone Glucose High density lipoprotein Hormones Infertility Insulin Insulin resistance Intervention Laboratory testing Low density lipoprotein Luteinizing hormone Medicine Medicine and Health Sciences Menstruation Meta-analysis Metabolism Obesity Ovaries Overweight Parameter estimation People and places Performance evaluation Pharmacology Physical Sciences Polycystic ovary syndrome Population studies Ranking Research and Analysis Methods Rosiglitazone Sex hormones Stein-Leventhal syndrome Systematic review Testosterone Triglycerides Weight reduction |
| title | The comparative effectiveness of 55 interventions in obese patients with polycystic ovary syndrome: A network meta-analysis of 101 randomized trials |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-16T12%3A10%3A50IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20comparative%20effectiveness%20of%2055%20interventions%20in%20obese%20patients%20with%20polycystic%20ovary%20syndrome:%20A%20network%20meta-analysis%20of%20101%20randomized%20trials&rft.jtitle=PloS%20one&rft.au=Abdel-Maboud,%20Mohamed&rft.date=2021-07-19&rft.volume=16&rft.issue=7&rft.spage=e0254412&rft.pages=e0254412-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0254412&rft_dat=%3Cgale_plos_%3EA669020681%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2553216393&rft_id=info:pmid/34280195&rft_galeid=A669020681&rft_doaj_id=oai_doaj_org_article_f650c14aafaa4386a88e0eaf7776d02b&rfr_iscdi=true |