Comparative study of the therapeutic effects of oral contraceptive pills containing desogestrel, cyproterone acetate, and drospirenone in patients with polycystic ovary syndrome.
OBJECTIVE
To compare the effects of oral contraceptive pills containing desogestrel, cyproterone acetate, and drospirenone, in polycystic ovary syndrome (PCOS), after 6 and 12 months of therapy.


METHODS
Double-blind randomized controlled trial.


METHODS
Gynecologic clinic of the first author.


METHODS
Women (n = 171) with PCOS (Androgen Excess Society criteria, 2006).


METHODS
The three-arm trial involved 58, 56, and 57 cases in desogestrel, cyproterone acetate, and drospirenone groups, respectively. Body mass index, abdominal circumference, hirsutism score (modified Ferriman Galwey), acne and acanthosis nigricans scores, and blood pressure were noted. Blood levels of total T, sex hormone-binding globulin, fasting glucose, and fasting insulin were measured. Free androgen index, glucose-insulin ratio, and homeostasis model assessment-insulin resistance were calculated. Follow-up was after 6 and 12 months of treatment.


METHODS
Primarily, absolute change in the Free Androgen Index score between the three groups and, secondarily, changes in the clinical and other hormonal and biochemical parameters were studied.


RESULTS
Six months of treatment showed similar effects. After 12 months, cyproterone acetate significantly decreased the modified Ferriman Galwey score (change = -5.29) compared with both desogestrel (change = -1.69) and drospirenone (change = -2.12); cyproterone acetate significantly increased sex hormone-binding globulin (change = 142.91) compared with desogestrel (change = 99.53); drospirenone significantly increased sex hormone-binding globulin (change = 131.52) compared with desogestrel; and cyproterone acetate significantly decreased the Free Androgen Index (change = -10.57) compared with desogestrel (change = -5.58).


CONCLUSIONS
No difference in effects after 6 months. At 12 months, cyproterone acetate showed the strongest antiandrogen activities. Effects on metabolic parameters were identical.


BACKGROUND
CTRI/2010/091/000332.
Department of Obstetrics and Gynaecology, SC Das Memorial Medical and Research Center, Jodhpur Park, Kolkata, India. drsudhindra54@gmail.com
Sudhindra Mohan
SM
Bhattacharya
Ayan
A
Jha
D000293:Adolescent; D000328:Adult; D000726:Androgen Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D000736:Androstenes / Q000008:administration & dosage* / Q000009:adverse effects; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D003280:Contraceptives, Oral, Synthetic / Q000008:administration & dosage / Q000009:adverse effects; D017373:Cyproterone Acetate / Q000008:administration & dosage* / Q000009:adverse effects; D017135:Desogestrel / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006628:Hirsutism / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000378:metabolism; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome; D055815:Young Adult
D000726:Androgen Antagonists; D000736:Androstenes; D001786:Blood Glucose; D003280:Contraceptives, Oral, Synthetic; D007328:Insulin; D000451:Mineralocorticoid Receptor Antagonists; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D017373:Cyproterone Acetate; D017135:Desogestrel; C035144:drospirenone