Abstract
BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) can improve metabolic parameters and significantly reduce weight and fat mass. Evidence regarding the use of SGLT2i in polycystic ovary syndrome (PCOS) is limited. The current systematic review compared the efficacy of SGLT2i with placebo or other active comparators in PCOS. METHODS: Randomized controlled trials (RCTs) involving patients with PCOS who are overweight and obese and receiving SGLT2i as intervention and placebo or any non-hormonal comparator as controls were identified through electronic databases. The outcomes of interest included changes in metabolic, hormonal, anthropometric and body composition parameters. RESULTS: Five RCTs involving 269 participants were included. Canagliflozin, empagliflozin, dapagliflozin and licogliflozin were studied either as monotherapy or in combination with metformin or exenatide. SGLT2i reduced insulin resistance, as evidenced by decreased homeostatic model assessment for insulin resistance and insulin and fasting plasma glucose levels. Reductions in body weight, body mass index, waist circumference and total body fat were observed with most of the SGLT2i. A reduction in dehydroepiandrosterone sulphate (DHEAS) levels was also observed in two RCTs, whereas a decrease in total testosterone level or free-androgen index was not associated with most SGLT2i. Improvements in menstrual irregularity and hirsutism scores were observed. Triglycerides were reduced, while low-density lipoprotein level was slightly increased with SGLT2i in most RCTs. Improvements in body composition and metabolic parameters were most prominent with a combination of SGLT2i with a glucagon-l ike peptide receptor-1 agonist (GLP1RA), while the combination of SGLT2i with metformin showed better effects on hormonal parameters. Adverse effects with SGLT2i were mostly mild and included genital infections. CONCLUSION: SGLT2i, when used as monotherapy or combined with metformin or GLP1RA, are a promising therapy for improving metabolic and hormonal parameters in PCOS.