Uğur ÜNLÜTÜRK, Rıfat EMRAL, Gökhan KABAÇAM, Ahmet Nuri KAMEL

İnsulin duyarlılaştırıcı ilaçlar metformin ve roziglitazonun polikistik over sendromunda etkinliklerinin karşılaştırılması

Amaç: Polikistik over hastalığı, doğurganlık çağındaki kadınlarda en sık görülen endokrin hastalığıdır. İnsulin direnci bu hastalık tablosunun ana patolojilerden birisidir. İnsulin duyarlılaştırıcı ajanlar ise bu sendromun tedavisinde klinik ve biyokimyasal açıdan başarı elde edilmesi amacıyla kullanılmasına karşın, bu ajanların PKOS’de kullanımını destekleyen direk veriler netlik kazanmamıştır. PKOS’da metformin ve roziglitazon tedavilerinin biyokimyasal ve klinik parametreler üzerine etkilerinin değerlendirmesi ve iki ilacın kıyaslanması. Metot: Çalışmaya PKOS tanısı almış 24 kadın dahil edildi. Tüm katılımcıların bazal antropometrik (VKİ, bel çevresi) ölçümleri kaydedildikten sonra adetin 2 ile 6. günleri arasında gece açlığını takiben açlık palzma glikozu, insulin, LH, FSH, DHEAS, total and serbest testosterone düzeyleri ölçüldü. İnsulin direnci göstergesi olarak HOMA-IR (Homeostasis model assessment score-insulin resistance) hesaplandı. Modifiye Ferriman Gallwey yöntemi ile hirsutizm skorlaması yapıldı. Sonrasında tüm kastılımcılar metformin (1700mg/gün) veya roziglitazon (4mg/gün) tedavilerine rastgele ayrıldılar. Yirmi dört haftalık tedavi süresi sonunda bazal değerlendirmesi yapılan tüm ölçütler tekrar değerlendirildi. Bazal ve son nokta ölçümleri tüm grupta ve tedavi gruplarında ayrı ayrı karşılaştırıldı. Bulgular: Bazal ölçümler içinde insulin ve serbest testosteron düzeyleri arasında istatistiksel olarak anlamlı bir ilişki saptandı. İnsulin duyarlılaştırıcı ilaçlar ile tedavi sonrasında tüm grup değerlendirildiğinde, serbest testosteron düzeyleri, hirsutizm skorları ve mastrüel siklus sıklığında istatistiksel olarak anlamlı biçimde düzelme gözlenirken (sırasıyla, P=.004, P=.049 ve P=.001), açlık insulin düzeylerinde ve HOMA-IR ölçümlerinde düzelme ise istatistiksel olarak anlamlı değildi. Tedavi grupları ayrı ayrı analiz edildiğinde, metformin grubu hirsutizm skorlarında istatistiksel olarak anlamlı olmayan bir düzelme gözlenirken diğer ölçütlerde benzer sonuçlar elde edildi. Sonuç: Bu bulgular, metformin ve roziglitazon tedavilerinin PKOS’nin klinik ve biyokimyasal bulgularında iyileşme sağladığını göstermektedir. Bu iki ilaç etkinliği açısından biri diğerine üstün olmadığı söylenebilir. Ancak daha çok denek içeren çalışmalara ihtiyaç vardır.

Comparison of the effectiveness of ınsulin sensitizing agents metformin and rosiglitazone in PCOS

Aim Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of child bearing-age women, and insulin resistance is one of the main characteristics of this syndrome. Although insulin sensitizing drugs are used to treat the clinical and biochemical features of PCOS, there is no certain data to offer using these agents in this syndrome. The aim of this study was to evaluate and compare the effectiveness of metformin versus rosiglitazone in the clinical and biochemical regression of PCOS. Methods: We enrolled 24 women with PCOS. Anthropometric measurements including body mass index (BMI) and waist circumference (waist) were obtained. All subjects underwent a hormonal assessment between 2nd and 6th day of menstrual cycle in which fasting plasma glucose (APG), insulin, LH, FSH, DHEAS, total and free testosterone levels measured after an overnight fasting. Homeostasis model assessment score (HOMA-IR) was calculated as a measure for insulin resistance. Hirsutism scores were assessed by using modified Ferriman Gallwey metod. All participants randomized either on metformin (1700 mg/day) or rosiglitazone (4mgr/day) treatment. After 24 weeks of application all pretreatment parameters assessed were reevaluated. Baseline and end-point measures were compared in the whole study cohort and also in the treatment groups separately. Results: There was a statistically significant correlation between basal insulin and free testosterone levels. When whole study cohorts are assessed after treatment with the insulin sensitizing drugs, free testosterone levels, hirsutism scores, and frequencies of menstrual cycles improved with significantly (p=.004, p=.049, and p=.001, respectively), while the improvement in fasting insulin levels and HOMA-IR measures did not reach statistical significance. When treatment groups were separately analyzed, similar results were achieved apart from the insignificant decrease in hirsutism scores within the metformin group. Conclusion: These findings suggest that both metformin and rosiglitazone improve clinical and biochemical parameters of PCOS. It might be suggested that the effectiveness of these two drugs are not different from one another.

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