Efficacy of acarbose with metformin and myo-inositol in dual combo therapy may enhance cardio-metabolic safety in PCOS: Study

The study showed that both the dual combination therapy (acarbose plus metformin and acarbose plus myo-inositol) increase the effectiveness of ameliorating the endocrinologic and metabolic complications of PCOS. The findings were published online in the European Journal of Obstetrics & Gynecology and Reproductive Biology.

"The reduction in fasting insulin (FI), HOMA-IR, triglycerides (TGL), and low-density lipoprotein (LDL) cholesterol observed in the acarbose plus myo-inositol group supports improved cardio-metabolic safety in women with PCOS," the researchers reported. "Similarly, the notable increase in sex hormone-binding globulin (SHBG) levels in the acarbose plus metformin group indicates a correction of excess androgen levels and a restoration of normal ovulatory function."sex hormone-binding globulin

Polycystic ovary syndrome (PCOS) is not only marked by reproductive issues but is also a complex, rapidly growing metabolic and endocrinologic disorder. Approximately 70% of women with PCOS exhibit insulin resistance. Raju Kamaraj, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India, and colleagues aimed to determine and compare the effectiveness of acarbose plus metformin and acarbose plus myo-inositol combination therapy in reducing the metabolic and endocrinologic complications of PCOS.

For this purpose, the researchers conducted an open-labeled RCT on 168 PCOS women attending the gynecology clinic at SRM MCH & RC, Chengalpattu.

Group A (n = 56) received metformin 500 mg three times daily (TID) alone. Group B (n = 54) was administered acarbose 25 mg TID for the first four weeks, increasing to 50 mg TID for the subsequent 20 weeks, in addition to metformin 500 mg TID. Group C (n = 54) received acarbose following the same dosing schedule alongside myo-inositol 1000 mg twice daily (BD). All parameters were assessed at baseline and after six months.

The study led to the following findings:

• There was a significant reduction of luteinizing hormone, LH: FSH (follicle stimulating hormone), total testosterone (TT), and HOMA-IR in all the groups.
• FSH increased only in the metformin group.
• An increase in serum progesterone and reduction in FI, TGL, and LDL were significant only in the acarbose plus myo-inositol group.
• SHBG and HDL increased significantly only in the acarbose plus metformin group.
• There were no changes in body mass index (BMI), total cholesterol (TC), and VLDL in any group.

In conclusion, the increase in SHBG levels in the acarbose plus metformin group indicates a reduction in circulating clinical and biochemical excess androgens. Additionally, the decrease in fasting insulin, HOMA-IR, triglycerides, and LDL cholesterol observed in the acarbose plus myo-inositol group suggests potential long-term cardio-metabolic safety for women with PCOS.

Reference:

Andavar, M., Kamaraj, R., Mahalingam Vijayakumar, T., & Murugesan, A. (2024). Effectiveness of dual combination therapy of acarbose plus metformin and acarbose plus myo-inositol in ameliorating the metabolic and endocrinologic complications of polycystic ovary syndrome – A randomized controlled trial. European Journal of Obstetrics & Gynecology and Reproductive Biology, 300, 6-11. https://doi.org/10.1016/j.ejogrb.2024.07.001