Romero, J. y Del Bono, J. C.
El presente trabajo tuvo como objetivo evaluar el efecto terapéutico de drogas insulino sensibilizadoras en mujeres con diagnóstico de Síndrome de Ovario Poliquístico (SOP), con o sin insulino resistencia, por comparación entre dos tratamientos: metformina vs. rosiglitazona. Para evaluar su efecto se consideró el restablecimiento de una normal función reproductiva en las pacientes. Utilizamos el tratamiento con metformina o rosiglitazona, durante un período mínimo de seis semanas, en pacientes con diagnóstico de SOP por imágenes ováricas ecográficas alteradas y anormalidades en diversos metabolitos bioquímicos, parámetros considerados internacionalmente como patognomónicos. Adicionalmente, antes del tratamiento, se evaluó en las pacientes si eran insulino resistentes o no. Ambas poblaciones de pacientes con SOP, tratadas con uno u otro fármaco, fueron semejantes en cuanto a la prevalencia de IR (50 % aproximadamente). La sensibilidad insulínica se normalizó o mejoró luego de 6-8 semanas de tratamiento, independientemente del fármaco utilizado. Los resultados obtenidos, en cuanto a recuperación de parámetros de función re p roductiva se re f i e re, indican que el tratam i e nto con metformina, en comparación al de rosiglitazona, fue más eficaz para la restauración de ciclos menstruales regulares (93,75 %), ovulatorios (86,67 %) y, por lo tanto, para posibilitar el embarazo espontáneo (41,67 %), tanto en pacientes con diagnóstico de insulino resistencia o no. Si bien los resultados del tratamiento con rosiglitazona fueron de menor envergadura (84,62 %, 45,46 % y 20 %, para recuperación de ciclos menstruales regulares, ovulatorios y embarazo, respectivamente), se requiere ampliar la población de pacientes SOP tratadas con rosiglitazona y, paralelamente, evaluar los resultados de la terapia metformina-rosiglitazona (dado que sus diferentes mecanismos de acción podrían sinergizarse), en pacientes con SOP. Esta terapéutica hoy es utilizada con gran suceso en el tratamiento de pacientes con Diabetes Mellitus tipo 2
The aim of this work was to evaluate the efficacy of the treatment with diff e rent enhancers of insulin sensitivity ( m e t f o rmin, MTF, and rosiglitazone, RSG) in pre-menopausal women diagnosed as having polycystic ovary s y ndrome (PCOS). The efficacy was considered by the recovering of normal reproductive function. PCOS was diagnosed by altered ultrasound ovaric image, oligo/an-ovulation, hyperandrogenism and reversed LH:FSH ratio of circulating concentrations. In addition, women were diagnosed, following international recommendations, as insulin resistant (IR) or not (NIR). Immediately followed to the diagnostic, women were randomly assigned to follow either treatment, MTF (1.5-2 g/day; n = 20 patients) or RSG (4-8 mg/day; n = 20), for minimal and maximal terms of 6 and 32 weeks, respectively. However, 4 (from the MTF group) and 7 (from the RSG group) women w e re discontinued, at diff e rent times of the treatment, for diff e rent reasons. From the total PCOS women re c e i v i n g either treatment (n = 29), 16 were diagnosed as IR (9 and 7 patients from the MTF and RSG groups, re s p e c t i v e l y ) . After 6-8 weeks of treatment, those women diagnosed as IR improved, or recovered normal, insulin sensitivity. From the group of patients receiving MTF (n = 16), a 93.75 % of them recovered normal regular menses, from them 86.67 % became ovulatory cycles and, when desired, 41.67 % became pregnant. The only one patient belonging to this group that did not recovered normal regular menses had been diagnosed as severe IR. In the g roup of patients receiving RSG (n = 13), an 84.62 % of them re c o v e red normal regular menses, a 45.46 % became ovulatory cycles, and, when desired, 20 % became pregnant. Two patients that did not re c o v e red norm a l menses in this group, one was sever IR and the other NIR. At the end of treatment, PCOS women normalized androgenemia and LH:FSH ratio at the beginning of a new cycle, although not all recovered ovulatory cycles. P regnancy, when desired, occurred spontaneously and, immediately, they were discontinued from therapy, regardless of the treatment received. All pregnancies developed normally and finalized (except one spontaneous early abortion of unknown cause, from a patient of MTF group) with normal newborn. In summary, our study strongly supports the efficacy of drugs enhancing insulin sensitivity in PCOS women, regardless of whether they were classically diagnosed as IR or not, for the recovery of normal reproductive life. However, the treatment with MTF resulted of more success than that of RSG for this aim. Because the treatment of PCOS women with MTF has been more extensively used than that of RSG in PCOS patients, in the future, the RSG treatment should be explored in a greater number of PCOS patients to arrive to a more precise conclusion. More o v e r, the combined MTF-RSG therapy, which is now available in the pharmaceutical market (used with great success in the tre a t m e n t of Diabetes Type 2 patients), could also be applied in PCOS women and, probably, might result of a better e fficacy for normalizing reproductive function in these patients.