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Home » Testosterone » Comparative efficacy of statins, metformin, spironolactone and combined oral contraceptives in reducing testosterone levels in women with polycystic…

A total of 281 articles were identified in the systematic search, and among these 9 articles were included in the network meta-analysis. The flowchart in Fig. 1 illustrates the process of including and excluding articles for this systematic review and network meta-analysis. The included studies were described in Table 3 [1,2,3,4,5,6,7,8,9].

Flow diagram for study selection

The interventions in the included studies were COCs, atorvastatin, simvastatin, spironolactone, simvastatin plus metformin (SmivMet), metformin plus spironolactone (MetSpiro), metformin alone, and placebo. There was a direct comparison between atorvastatin and placebo and between simvastatin and metformin; however, no trials made a direct comparison between statins and other therapies. Therefore, a network meta-analysis deemed necessary to provide an indirect comparison between the interventions (Fig. 2). The summary of the results from the inconsistency test and the quality assessment of the included studies and risk of bias table were provided respectively in Table S1 and Figures S1 and S2 of the supplementary material.

Network plot of all interventions in the analysis

Metformin was the only management strategy that was evaluated directly to most of the other strategies. When compared to metformin, the pairwise comparison showed no significant difference in reducing the testosterone level for all management strategies. The results from the pairwise meta-analysis are presented in Table 4 above the leading diagonal.

In the network meta-analysis, atorvastatin showed greater reduction in testosterone level compared to COC (MD 2.78, 95%CrI 3.60, 1.97), spironolactone plus metformin (MD 2.83, 95%CrI 3.80, 1.87), simvastatin (MD 2.88, 95%CrI 3.85, 1.92), spironolactone (MD 2.90, 95%CI 3.77, 2.02), simvastatin plus metformin (MD 2.93, 95%CrI 3.79, 2.06), metformin (MD 2.97, 95%CrI 3.69, 2.25), lifestyle modification (MD 3.02, 95%CrI 3.87, 2.18), and placebo (MD 3.04, 95%CrI 3.56, 2.53). The results from network meta-analysis is presented in Table 4 below the leading diagonal.

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Comparative efficacy of statins, metformin, spironolactone and combined oral contraceptives in reducing testosterone levels in women with polycystic...

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Home » Testosterone » Comparative efficacy of statins, metformin, spironolactone and combined oral contraceptives in reducing testosterone levels in women with polycystic…