Thiazolidinediones for treatment of polycystic ovary syndrome

Objective. To review the pathophysiology and treatment of polycystic ovary syndrome (PCOS) and the evidence for use of thiazolidinediones in the treatment of this syndrome. Data Sources. We conducted a MEDLINE database search for English-language literature published from January 1966-July 2004. Key terms used were thiazolidinediones, troglitazone, rosiglitazone, pioglitazone, polycystic ovary syndrome, and PCOS. Bibliographies in the relevant articles were reviewed for additional references. Selection. All clinical trials were reviewed. Data Synthesis. Troglitazone has been evaluated in numerous clinical trials of women with PCOS. These trials provided a body of evidence supporting the efficacy of troglitazone for management of PCOS complications, such as insulin resistance, hyperandrogenism, and anovulation. Due to safety concerns, however, troglitazone is no longer marketed in the United States. Clinical data are emerging regarding the utility of newer, safer thiazolidinediones, such as pioglitazone and rosiglitazone, for this patient population. The available literature provides evidence that these newer agents improve insulin sensitivity, glycemic control, hormone responsiveness, menstrual regularity, and ovulation rates. Pioglitazone and rosiglitazone have been well tolerated in clinical studies and have an improved safety profile in terms of liver toxicity. Conclusion. Pioglitazone and rosiglitazone should be considered a second-line treatment alternative to metformin for management of women with PCOS who are resistant to insulin or who are obese.