Update on the effects of GLP-1 receptor agonists for the treatment of polycystic ovary syndrome

ABSTRACT

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) offer a unique opportunity to simultaneously address various comorbid associated conditions and phenotypic presentations of polycystic ovary syndrome (PCOS) as these agents improve insulin sensitivity, reduce cardiovascular disease (CVD) risk, result in weight loss, and improve nonalcoholic fatty liver disease.

Areas covered: The authors describe trials conducted during the last 5 years and provide an update on exenatide and liraglutide use in PCOS women. Information from the studies investigating GLP-1 RAs effects on reducing CVD risk in PCOS is also presented.

Expert opinion: Exenatide and liraglutide are good options for the treatment of PCOS when used alone or in combination with metformin. Especially strong consideration should be given to GLP-1 RAs when developing treatment strategies for PCOS women who are overweight or obese, glucose intolerant, have CVD or its attendant risk factors, and/or are seeking treatment for infertility.

KEYWORDS:

• Exenatide
• liraglutide
• PCOS
• weight reduction
• infertility

Article Highlights

• Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are alternative to metformin for the treatment of polycystic ovary syndrome (PCOS).

• GLP-1 RAs do not increase risk of hypoglycemia and have a good safety profile with most frequent adverse event being mild to moderate gastrointestinal discomfort (nausea, vomiting, abdominal distension).

• Exenatide (a short acting GLP-1 RA with a half-life of 2.4 hours) and liraglutide (a longer acting agent with a half-life of 13 hours) remain the only two GLP-1 RAs that have been studied in PCOS women.

• GLP-1 RAs have shown significant improvements in insulin action, cardiovascular disease (CVD) risk, weight reduction (including waist circumference), and reproductive function including increased pregnancy rates in overweight or obese PCOS women.

• GLP-1 RAs have resulted in significant reductions in liver fat and NALFD, visceral adipose tissue, triglycerides, and total cholesterol.

• Combination of GLP-1 RA with metformin appears to be superior to either single agent in reducing body weight, insulin resistance, hyperandrogenism, and improving menstrual cyclicity and ovulation.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.