The effectiveness and safety of exenatide in the treatment of polycystic ovary syndrome: A systematic review and meta-analysis

Background: Polycystic ovary syndrome (PCOS) is the commonest cause of anovulatory infertility in women of childbearing age. Randomized controlled trials have reported that exenatide and metformin are effective in the treatment of PCOS. In this article, we aim to assess the effectiveness and safety of exenatide/exenatide + metformin in patients suffering from PCOS. Methods Randomized control trials (RCTs) of exenatide therapy were searched through electronic databases. Eligible studies were identified by two reviewers independently. Outcomes were analyzed through Revman 5.4. Results Nine RCTs of 96 studies on 1149 women with PCOS were included to be analyzed, and among the nine RCTs, eight studies compared exenatide with metformin. Our meta-analysis demonstrated that exenatide was more successfully tested in terms of pregnancy rate, menstrual frequency ratio (MFR), sex hormone binding globulin (SHBG), FSH. The reduction in total testosterone (TT), weight, BMI, waist circumference (WC), waist-hip ratio, fasting insulin (FINS) and homeostasis model assessment-insulin resistance (HOMA-IR) were more significant after treatment with exenatide. In terms of safety, exenatide had a lower diarrhea rate, compared with metformin. In the other three studies, exenatide combined with metformin was compared with metformin. Exenatide combined metformin was more effective in improving SHBG, Matsuda index and reducing free androgen index (FAI), Weight and WC. There was no significant difference on other data. Conclusions Exenatide is more effective than metformin and has high safety for women with PCOS. Considering the evidence of effectiveness and safety, exenatide may be a better treatment method for women with PCOS. Systematic Review Registration: INPLASY https://inplasy.com/inplasy-protocols/ ID: 10.37766/inplasy2022.11.0055.