Flutamide-metformin plus an oral contraceptive (OC) for young women with polycystic ovary syndrome: switch from third- to fourth-generation OC reduces body adiposity.
BACKGROUND
Low-dose flutamide-metformin has been developed as a background therapy for non-obese adolescents and young women with hyperinsulinaemic hyperandrogenism, a variant of polycystic ovary syndrome (PCOS). We verified whether the lipolytic efficacy of flutamide-metformin in women with PCOS is enhanced by giving an oral contraceptive (OC) co-therapy that contains drospirenone, instead of gestodene, as progestin.


METHODS
An open-labelled study was carried out in which non-obese women with PCOS (n = 29; age approximately 20 years), who had been on a combination of flutamide (62.5 mg/day), metformin (850 mg/day) and ethinylestradiol-gestodene for 8-15 months, were randomized for replacement of the gestodene OC by a drospirenone OC. Assessments of endocrine-metabolic state and body composition (by dual-energy X-ray absorptiometry) were performed at randomization and after 6 months.


RESULTS
The switch to drospirenone OC was accompanied by a reduction of total and abdominal fat (mean -0.8 and -0.5 kg) and by an increment of lean body mass (+0.6 kg; all P < 0.01), so that body adiposity was strikingly reduced without changing body weight.


CONCLUSIONS
In non-obese women with PCOS, low-dose flutamide-metformin reduces total and abdominal fat excess more effectively if contraceptive co-therapy contains drospirenone, instead of gestodene, as progestin.
Ibáñez
Lourdes
L
Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Spain. libanez@hsjdbcn.org
De Zegher
Francis
F
D000005:Abdomen; D000273:Adipose Tissue / Q000187:drug effects; D000293:Adolescent; D000328:Adult; D000726:Androgen Antagonists / Q000008:administration & dosage*; D003276:Contraceptives, Oral / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004967:Estrogens / Q000008:administration & dosage; D004997:Ethinyl Estradiol / Q000008:administration & dosage; D005260:Female; D005485:Flutamide / Q000008:administration & dosage*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008687:Metformin / Q000008:administration & dosage*; D009652:Norpregnenes / Q000008:administration & dosage; D009765:Obesity / Q000150:complications / Q000188:drug therapy*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*
D000726:Androgen Antagonists; D003276:Contraceptives, Oral; D004967:Estrogens; D007004:Hypoglycemic Agents; D009652:Norpregnenes; C033273:Gestodene; D004997:Ethinyl Estradiol; D005485:Flutamide; D008687:Metformin