Comparative Effectiveness of Letrozole versus Metformin for Ovulation Induction in Women with PCOS
Abstract
Objective: This study serves to compare the effectiveness of letrozole and metformin for ovulation induction in women with polycystic ovary syndrome based on ovulation, pregnancy, and live birth outcomes.
Methods: This study was conducted as a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Literature searches were performed in PubMed, Scopus, Web of Science, the Cochrane Library, and ScienceDirect. Randomized controlled trials comparing letrozole and metformin in women with polycystic ovary syndrome were included. Primary outcomes included ovulation rate, clinical pregnancy rate, and live birth rate.
Result: Fourteen randomized controlled trials involving 3,314 patients were analyzed. Meta-analysis showed that letrozole significantly improved ovulation rate compared to metformin (odds ratio 1.29; 95% confidence interval 1.09-1.53). Letrozole also demonstrated superior clinical pregnancy outcomes (odds ratio 1.65; 95% confidence interval 1.41-1.93) and higher live birth rates (odds ratio 1.49; 95% confidence interval 1.26-1.75). Metformin primarily improved metabolic parameters but showed limited effectiveness as monotherapy for reproductive outcomes.
Discussion: Letrozole acts directly on ovarian follicular development, whereas metformin mainly improves insulin resistance. These differences explain the superior reproductive outcomes observed for letrozole.
Conclusion: Letrozole is more effective than metformin for ovulation induction and reproductive outcomes in women with polycystic ovary syndrome and should be considered a first-line therapy.
Perbandingan Efektivitas Letrozole versus Metformin untuk Induksi Ovulasi pada Wanita dengan PCOS
Abstrak
Tujuan: Penelitian ini bertujuan untuk membandingkan efektivitas letrozol dan metformin dalam induksi ovulasi pada wanita dengan sindrom ovarium polikistik berdasarkan luaran ovulasi, kehamilan, dan kelahiran hidup.
Metode: Penelitian ini merupakan tinjauan sistematis dan meta-analisis yang mengikuti pedoman Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Pencarian literatur dilakukan pada basis data PubMed, Scopus, Web of Science, Cochrane Library, dan ScienceDirect. Uji klinis teracak yang membandingkan letrozol dan metformin pada pasien sindrom ovarium polikistik dimasukkan dalam analisis. Luaran utama meliputi angka ovulasi, angka kehamilan klinis, dan angka kelahiran hidup.
Hasil: Sebanyak 14 uji klinis teracak dengan total 3.314 pasien dianalisis. Meta-analisis menunjukkan bahwa letrozol secara signifikan meningkatkan angka ovulasi dibandingkan metformin (rasio odds 1,29; interval kepercayaan 95% 1,09 - 1,53). Letrozol juga menunjukkan angka kehamilan klinis yang lebih tinggi (rasio odds 1,65; interval kepercayaan 95% 1,41 - 1,93) serta peningkatan angka kelahiran hidup (rasio odds 1,49; interval kepercayaan 95% 1,26 - 1,75). Metformin terutama memperbaiki parameter metabolik hanya saja memiliki efektivitas yang lebih terbatas terhadap luaran reproduksi jika digunakan sebagai monoterapi.
Diskusi: Letrozol bekerja langsung pada perkembangan folikel ovarium, sedangkan metformin terutama memperbaiki resistensi insulin. Perbedaan mekanisme ini menjelaskan keunggulan luaran reproduksi pada terapi letrozol.
Kesimpulan: Letrozol lebih efektif dibandingkan metformin dalam induksi ovulasi dan luaran reproduksi pada wanita dengan sindrom ovarium polikistik.
Keywords
Full Text:
PDFReferences
Azziz R, Carmina E, Chen Z, Dunaif A, Laven JSE, Legro RS, et al. Polycystic ovary syndrome. Nat Rev Dis Primers. 2016;2:16057.
Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, et al. The management of anovulatory infertility in women with polycystic ovary syndrome. Endocr Rev. 2016;37(5):487–525.
Palomba S, Falbo A, Zullo F, Orio F. Evidence-based and potential benefits of metformin in the polycystic ovary syndrome: a comprehensive review. Endocr Rev. 2009;30(1):1–50.
Casper RF, Mitwally MFM. Aromatase inhibitors for ovulation induction. J Clin Endocrinol Metab. 2006;91(3):760–71.
Franik S, Eltrop SM, Kremer JAM, Kiesel L, Farquhar C. Aromatase inhibitors for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2018;5:CD010287.
Amer SA, Smith J, Mahran A, Fox P, Fakis A. Double-blind randomized controlled trial of letrozole versus clomiphene citrate in women with polycystic ovary syndrome. Hum Reprod. 2017;32(8):1631–8.
Morley LC, Tang T, Yasmin E, Norman RJ, Balen AH. Insulin-sensitising drugs in PCOS. Cochrane Database Syst Rev. 2017;11:CD003053.
Tang T, Lord JM, Norman RJ, Yasmin E, Balen AH. Insulin-sensitising drugs for women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2012;5:CD003053.
Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for PCOS. Hum Reprod. 2018;33(9):1602–18.
Wang R, Kim BV, van Wely M, et al. Treatment strategies for women with WHO group II anovulation. Hum Reprod Update. 2017;23(6):687–708.
McCartney CR, Marshall JC. Clinical practice: PCOS. N Engl J Med. 2016;375:54–64.
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised consensus on PCOS. Hum Reprod. 2004;19(1):41–7.
Legro RS, Brzyski RG, Diamond MP, Coutifaris C, Schlaff WD, Casson P, et al. Letrozole versus clomiphene for infertility in PCOS. N Engl J Med. 2014;371(2):119–29.
Costello MF, Misso ML, Balen A, et al. Evidence summaries for PCOS guideline. Hum Reprod Open. 2019;2019(1):hoy021.
Goodman NF, Cobin RH, Futterweit W, et al. AACE PCOS guidelines. Endocr Pract. 2015;21(11):1291–1300.
DOI: http://dx.doi.org/10.24198/obgynia.v9i2.1121
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
_CROSREF22.jpg)
