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Contesa -> RE: SIOFOR (lek za stimulaciju jajnih celija) (29.8.2011 2:53:27)
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Postovane kolegice na Forumu,
Buduci da je puno pitanja oko Metformina i njegovim derivatima, evo vam nekako kolko tolko simplificiran clanak koji govori o indikaciji Metformina i PCOS-a:
Polycystic ovary syndrome
Antidiabetic therapy has been proposed as a treatment for polycystic ovary syndrome (PCOS), a condition frequently associated with insulin resistance, since the late 1980s. The use of metformin in PCOS was first reported in 1994, in a small study conducted at the University of the Andes, Venezuela. The United Kingdom's National Institute for Health and Clinical Excellence recommended in 2004 that women with PCOS and a body mass index above 25 be given metformin for anovulation and infertility when other therapy has failed to produce results. However, two large clinical studies completed in 2006–2007 returned mostly negative results, with metformin being no better than placebo, and a metformin-clomifene combination no better than clomifene alone. Reflecting this, subsequent reviews noted large randomized control trials have in general not shown the promise suggested by the early small studies. U.K. and international clinical practice guidelines do not recommend metformin as a first-line treatment or do not recommend it at all, except for women with glucose intolerance. The guidelines suggest clomiphene as the first medication option and emphasize lifestyle modification independently from the drug treatment.
In a dissenting opinion, a systematic review of four head-to-head comparative trials of metformin and clomifene found them equally effective for infertility.A BMJ editorial noted four positive studies of metformin were in people not responding to clomifene, while the population in the negative studies was drug-naive or uncontrolled for the previous treatment. The editorial suggested metformin should be used as a second-line drug if clomifene treatment fails. Another review recommended metformin unreservedly as a first-line treatment option because it has positive effects not only on anovulation, but also on insulin resistance, hirsutism, and obesity often associated with PCOS. A large Cochrane Collaboration review of 27 randomized clinical trials found metformin improves ovulation and pregnancy rates, particularly when combined with clomifene, but is not associated with any increase in the number of live births.
The design of the negative trials may be one of the explanations for the contradictory results. For example, using live birth rate instead of pregnancy as the endpoint may have biased some trials against metformin, which works slower than clomifene. Another explanation may be different efficacy of metformin in different populations. The negative trials contained a large percent of obese and previously untreated people whose response to metformin may be weaker.
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