Metformin Therapy for Acne in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis
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SYSTEMATIC REVIEW
Metformin Therapy for Acne in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta‑analysis Hsuan Yen1 · Yu‑Tung Chang2 · Fui‑Jun Yee2 · Yu‑Chen Huang1,3,4
© Springer Nature Switzerland AG 2020
Abstract Background Acne is one of the cutaneous manifestations of polycystic ovary syndrome (PCOS). There is limited evidence on metformin use for treatment of acne in PCOS patients. Objective Our aim was to conduct a systematic review and meta-analysis to evaluate the efficacy of metformin for treatment of PCOS-related acne. Methods On November 23, 2019, we searched PubMed, the Cochrane Library, and Embase databases for human clinical studies in any language. The keywords included ‘acne’ and ‘polycystic ovary syndrome’ combined with ‘metformin,’ ‘biguanide,’ or ‘glucophage.’ We included randomized controlled trials (RCTs), non-randomized controlled trials (NRCTs), and open-label studies on patients with PCOS treated with metformin. We calculated standardized mean differences (SMDs) for acne scores and odds ratios (ORs) for presence of acne, with 95% confidence intervals (CIs). Quality assessment was performed using the Cochrane Collaboration risk of bias instrument for RCTs. NRCTs and open-label studies were assessed using the adapted methodological index for nonrandomized studies (MINORS). Results We included 51 studies on 2405 PCOS patients. Metformin as adjuvant therapy led to greater improvement of acne scores than the same therapy without metformin (SMD − 0.256; 95% CI − 0.439 to − 0.074). Pooling pre- and post-metformin therapy data showed significant decrease of acne scores after metformin use (SMD − 0.712; 95% CI − 0.949 to − 0.476). Presence of acne decreased significantly after metformin treatment (OR 0.362; 95% CI 0.271 to 0.485). Limitations There was heterogeneity across some studies due to different acne assessment scales, metformin dosages, and treatment durations. Conclusions For PCOS patients, metformin as stand-alone or adjuvant therapy was associated with improvement of acne. More randomized controlled trials are needed to validate these results. Registration PROSPERO registration number CRD42020159656. Key Points
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40257-020-00565-5) contains supplementary material, which is available to authorized users. * Yu‑Chen Huang [email protected] 1
Department of Dermatology, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City 116, Taiwan
2
Department of Medical Education, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
3
Research Center of Big Data and Meta‑Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
4
Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Metformin, either as stand-alone or adjuvant therapy, is associated with improvement of acne in polycystic ovary syndrome patients. After considerin
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