Efficacy and Safety of Anti-Androgens in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

    August 2023 in “ EClinicalMedicine ”
    Simon Alesi, Maria Forslund, Johanna Melin, Daniela Romualdi, Alexia S Peña, Chau Thien Tay, Selma F. Witchel, Helena Teede, Aya Mousa
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    TLDR Anti-androgens can help manage some PCOS symptoms better than metformin but are not more effective than placebos or birth control pills for other symptoms.
    This systematic review and meta-analysis examined the efficacy and safety of anti-androgens in managing polycystic ovary syndrome (PCOS), pooling data from 13 studies involving 961 participants. The anti-androgens used were finasteride, flutamide, spironolactone, and bicalutamide. The results showed that anti-androgens combined with lifestyle changes were superior to metformin combined with lifestyle changes for treating hirsutism and other symptoms. However, they were not superior to a placebo combined with lifestyle changes. Daily use of anti-androgens was more effective for hirsutism than use every three days. Combining anti-androgens with COCP resulted in poorer lipid profiles compared with COCP ± placebo. The study concluded that current evidence does not support the use of anti-androgens preferentially to COCPs to treat hyperandrogenism in PCOS. Anti-androgens could be considered to treat hirsutism in PCOS, where COCPs are contraindicated, poorly tolerated, or present a sub-optimal response after a minimum 6-month period. The study also highlighted the need for more research on adolescents with PCOS, as only two studies in this review included this demographic.
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