The efficacy and safety of GLP-1 agonists in PCOS women living with obesity in promoting weight loss and hormonal regulation: A meta-analysis of randomized controlled trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 39178623 · doi:10.1016/j.jdiacomp.2024.108834
What was done
The authors conducted a systematic review and meta-analysis searching PubMed, Cochrane Central, Scopus, and Embase for randomized controlled trials (RCTs) evaluating GLP-1 receptor agonists (GLP1-RAs) versus placebo in women with obesity diagnosed with polycystic ovarian syndrome (PCOS) per Rotterdam criteria. Primary outcomes were body mass index (BMI), waist circumference, triglycerides, total testosterone, total cholesterol, and HOMA-IR. Pooled mean differences (MD) and 95% confidence intervals (CI) were calculated using a random-effects model.
What was found
Four RCTs with 176 participants were included (liraglutide in 103 [58%] and semaglutide in 23 [13%]). Compared to placebo, GLP1-RA treatment significantly decreased waist circumference (MD: -5.16 cm; 95% CI: -6.11 to -4.21; p < 0.00001), BMI (MD: -2.42; 95% CI: -3.10 to -1.74; p < 0.00001), serum triglycerides (MD: -0.20; 95% CI: -0.30 to -0.11; p < 0.00001), and total testosterone (MD: -1.33; 95% CI: -2.55 to -0.12; p = 0.03). No significant difference was observed for total cholesterol (MD: -0.04; 95% CI: -0.10 to 0.01; p = 0.15) or HOMA-IR (MD: -0.30; 95% CI: -0.92 to 0.32; p = 0.35). Adverse events were reported for 112 patients, with 49 experiencing mild side effects including nausea and abdominal pain.
Why it matters
This review provides quantitative evidence that GLP-1 receptor agonists reduce weight and lower total testosterone in women with obesity and PCOS, supporting their potential role in metabolic and hyperandrogenic management.
Limits
The total evidence base is very small, encompassing only four RCTs and 176 patients. The majority of participants received liraglutide, with limited representation of semaglutide or other GLP-1 agonists. The abstract did not report intervention duration, specific drug dosages, ovulatory or fertility outcomes, or long-term safety, and the intervention showed no significant effect on total cholesterol or HOMA-IR.
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