Inositol safe and non-inferior to Metformin for PCOS management

Hungary: A new study found that Inositol is safe, effective, and non-inferior to metformin in the management of the polycystic ovarian syndrome. The study results were published in the journal Reproductive Biology and Endocrinology. 

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder causing infertility. Insulin resistance plays a major role in the pathogenesis of PCOS. Metformin is commonly used to treat insulin resistance in polycystic ovary syndrome (PCOS), but gastrointestinal issues are the main side effects. Recent literature suggests that Inositol supplementations are potential alternatives to metformin due to fewer side effects. Hence researchers from Hungary conducted a systematic review and meta-analysis to evaluate the efficacy and safety of Inositol in treating PCOS. 

Using a predefined search key and following the PRISMA 2020 guidelines, the present systematic search was performed in CENTRAL, MEDLINE, and Embase from the inception until October 20th, 2021. Any randomized controlled trials (RCTs) that included women diagnosed with PCOS and compared any inositols with metformin or placebo were considered eligible for the study. Cycle normalization was the primary outcome, whereas secondary outcomes were body mass index (BMI), parameters of carbohydrate metabolism, and clinical and laboratory hyperandrogenism. Results were reported as risk ratios or mean differences (MDs) with 95% confidence intervals (CIs).

Key findings:

• Twenty-six RCTs were identified with 1691 patients (806 inositols, 311 with placebo, and 509 metformin groups).  
• A higher risk of having a regular menstrual cycle by 1.79 times was found than with a placebo in patients treated with inositols. 
• Inositols were found to be non-inferior when compared to metformin.
• Inositol treatment was found to induce a greater decrease in BMI, free testosterone, total testosterone, androstenedione, glucose levels, and AUC insulin when compared to placebo. 
• Inositol increased sex-hormone-binding globulin significantly compared to the placebo. 

Thus, Inositols were found to be beneficial in all aspects, were non-inferior, and showed a promising alternative to PCOS. 

Further reading: Greff D, Juhász AE, Váncsa S, et al. Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Reprod Biol Endocrinol. 2023;21(1):10. Published 2023 Jan 26. doi: 10.1186/s12958-023-01055-z