Discussion
nausea or vomiting, Weight loss, diabetes mellitus, adiposity, oligo-ovulatory PCOS, dyslipidemia, obese, diarrhea, metabolic impairment, hyperinsulinism, human GLP-1(7–36, hyperandrogenism, weight loss, nausea, vomiting, tumor necrosis, gastrointestinal adverse, polycystic ovarian, PCOS, overweight
DISORDER, OBESE, TUMOR NECROSIS, DIABETES MELLITUS, ANDROGEN EXCESS, HYPERINSULINISM, INSULIN RESISTANCE, ADIPOSITY, HYPERANDROGENISM, PATHOLOGY, PATHOGENESIS, DYSLIPIDEMIA
The recent introduction of several medicines for the treatment of diabetes mellitus has increased the therapeutic choices of PCOS. Consideration of GLP-1RAs as the potential therapeutic modality of PCOS has grown (Beinaglutide is a recombinant human GLP-1 with the same human-derived amino acid sequence (In this present study, the combination therapy of metformin and beinaglutide demonstrated synergistic larger effects on the loss of body weight and BMI. Weight loss ranging from 1.38-7.7kg is consistent with previous studies involving obese patients using GLP-1RAs (There is no standard treatment for PCOS which is only addressed symptomatically currently (The pathology mechanisms of PCOS is a vicious circle of hyperandrogenism facilitating abdominal visceral adiposity which aggravates androgen secretion of ovarian and/or adrenal origin by the direct modulation of cytokines such as tumor necrosis factor, interleukin 6, and leptin or the indirect induction of insulin resistance and hyperinsulinism (The improvement of hormonal disorder was most dramatic with COMB therapy wherein the TT and LH/FSH levels decreased over 12 weeks. However, hormonal disturbances were not consistently improved on metformin treatment in our study. Although COMB treatment was associated with a marked reduction in LH/FSH ratio in our study, no significant between-treatment difference exists in both groups. In accordance with our findings, Jensterle et al. found improved TT with the liraglutide. They treated 43 overweight women with oligo-ovulatory PCOS with liraglutide, or combined with metformin for 12 weeks and found the combined treatment markedly reduce TT level, while no change was found with liraglutide monotherapy (Given that polycystic ovarian morphology was included as a diagnostic criterion from the Rotterdam Consensus Conference in 2003 (IR plays a significant role in the metabolic impairment of PCOS, which comes with hormonal imbalances, worsening each other in a vicious cycle of PCOS pathogenesis (Androgen excess has been found to increase the production of free fatty acids and inflammatory cytokines, which are substantially linked to dyslipidemia and impacts 70% of PCOS patients (Treatment with GLP-RAs and metformin frequently results in gastrointestinal adverse effects including nausea, vomiting, and diarrhea. They often occurred in the first 4 weeks of treatment with mild to moderate intensity and subside over time. It is noteworthy that previous studies investigating combination therapy of liraglutide and metformin did not show more frequent cases of nausea or vomiting than studies of liraglutide only (Our study had some limitations. It was unable to determine the sustainability of weight loss and endocrine metabolic effects by COMB therapy for 12 weeks. The sample size was relatively small in each treatment arm, and larger multi-center randomized studies are required to set a placebo group and a beinaglutide alone group for reducing bias and clarifying the safety profile in obese PCOS women. The lack of information on improvements in free testosterone and SHBG which represent directly the androgen activity of the whole body should be addressed in future studies. Finally, the tolerability of beinaglutide sharing 100% homology with human GLP-1(7–36), versus other GLP-1RAs in the treatment of PCOS patients needs to be further explored.