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N-acetylcysteine for polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled clinical trials.

Thakker D, Raval A, Patel I, Walia R - Obstet Gynecol Int (2015)

Bottom Line: There was no significant difference in rates of the miscarriage, menstrual regulation, acne, hirsutism, and adverse events, or change in body mass index, testosterone, and insulin levels with NAC as compared to placebo.Conclusions.NAC showed significant improvement in pregnancy and ovulation rate as compared to placebo.

View Article: PubMed Central - PubMed

Affiliation: Department of Pharmacology, SAL Institute of Pharmacy, Ahmadabad, Gujarat 380060, India.

ABSTRACT
Objective. To review the benefits and harms of N-acetylcysteine (NAC) in women with polycystic ovary syndrome (PCOS). Method. Literature search was conducted using the bibliographic databases, MEDLINE (Ovid), CINAHL, EMBASE, Scopus, PsyInfo, and PROQUEST (from inception to September 2013) for the studies on women with PCOS receiving NAC. Results. Eight studies with a total of 910 women with PCOS were randomized to NAC or other treatments/placebo. There were high risk of selection, performance, and attrition bias in two studies and high risk of reporting bias in four studies. Women with NAC had higher odds of having a live birth, getting pregnant, and ovulation as compared to placebo. However, women with NAC were less likely to have pregnancy or ovulation as compared to metformin. There was no significant difference in rates of the miscarriage, menstrual regulation, acne, hirsutism, and adverse events, or change in body mass index, testosterone, and insulin levels with NAC as compared to placebo. Conclusions. NAC showed significant improvement in pregnancy and ovulation rate as compared to placebo. The findings need further confirmation in well-designed randomized controlled trials to examine clinical outcomes such as live birth rate in longer follow-up periods. Systematic review registration number is CRD42012001902.

No MeSH data available.


Related in: MedlinePlus

Cochrane risk of bias rool summary for included studies.
© Copyright Policy - open-access
Related In: Results  -  Collection


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fig2: Cochrane risk of bias rool summary for included studies.

Mentions: Figure 2 describes the summary of risk of bias among the included studies. The methods for randomization were unclear in six studies. Only two studies described the use of computer generated randomization list for sequence allocation [21, 22]. Treatment allocation was concealed by administration of third party (nurse) using opaque sealed envelopes in four studies [14, 20–22], unclear in three studies [18, 19], and not done in one study [28]. Only four studies had low-risk of performance bias due to proper blinding [14, 17, 20, 22], and two studies [21, 28] were open-label with high risk of performance bias, while in remaining two studies blinding was unclear. Four studies [14, 17, 19, 20] had high risk of selective reporting bias especially on primary outcomes and safety outcomes. Three studies reported outcomes, which were not specified in the protocol. Those outcomes were homeostasis model assessment for insulin resistance (HOMA-IR) and Ferriman-Gallwey scale, fasting glucose, fasting insulin and glucose/insulin ratio, lipid profile and TNF-alpha, acne, infertility, and weight gain and testosterone level. Two studies had high risk of attrition bias with attrition rate of more than 20% [17, 18].


N-acetylcysteine for polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled clinical trials.

Thakker D, Raval A, Patel I, Walia R - Obstet Gynecol Int (2015)

Cochrane risk of bias rool summary for included studies.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4306416&req=5

fig2: Cochrane risk of bias rool summary for included studies.
Mentions: Figure 2 describes the summary of risk of bias among the included studies. The methods for randomization were unclear in six studies. Only two studies described the use of computer generated randomization list for sequence allocation [21, 22]. Treatment allocation was concealed by administration of third party (nurse) using opaque sealed envelopes in four studies [14, 20–22], unclear in three studies [18, 19], and not done in one study [28]. Only four studies had low-risk of performance bias due to proper blinding [14, 17, 20, 22], and two studies [21, 28] were open-label with high risk of performance bias, while in remaining two studies blinding was unclear. Four studies [14, 17, 19, 20] had high risk of selective reporting bias especially on primary outcomes and safety outcomes. Three studies reported outcomes, which were not specified in the protocol. Those outcomes were homeostasis model assessment for insulin resistance (HOMA-IR) and Ferriman-Gallwey scale, fasting glucose, fasting insulin and glucose/insulin ratio, lipid profile and TNF-alpha, acne, infertility, and weight gain and testosterone level. Two studies had high risk of attrition bias with attrition rate of more than 20% [17, 18].

Bottom Line: There was no significant difference in rates of the miscarriage, menstrual regulation, acne, hirsutism, and adverse events, or change in body mass index, testosterone, and insulin levels with NAC as compared to placebo.Conclusions.NAC showed significant improvement in pregnancy and ovulation rate as compared to placebo.

View Article: PubMed Central - PubMed

Affiliation: Department of Pharmacology, SAL Institute of Pharmacy, Ahmadabad, Gujarat 380060, India.

ABSTRACT
Objective. To review the benefits and harms of N-acetylcysteine (NAC) in women with polycystic ovary syndrome (PCOS). Method. Literature search was conducted using the bibliographic databases, MEDLINE (Ovid), CINAHL, EMBASE, Scopus, PsyInfo, and PROQUEST (from inception to September 2013) for the studies on women with PCOS receiving NAC. Results. Eight studies with a total of 910 women with PCOS were randomized to NAC or other treatments/placebo. There were high risk of selection, performance, and attrition bias in two studies and high risk of reporting bias in four studies. Women with NAC had higher odds of having a live birth, getting pregnant, and ovulation as compared to placebo. However, women with NAC were less likely to have pregnancy or ovulation as compared to metformin. There was no significant difference in rates of the miscarriage, menstrual regulation, acne, hirsutism, and adverse events, or change in body mass index, testosterone, and insulin levels with NAC as compared to placebo. Conclusions. NAC showed significant improvement in pregnancy and ovulation rate as compared to placebo. The findings need further confirmation in well-designed randomized controlled trials to examine clinical outcomes such as live birth rate in longer follow-up periods. Systematic review registration number is CRD42012001902.

No MeSH data available.


Related in: MedlinePlus