REVIEW ARTICLE PEDIATRICS Volume 137, number 5, May 2016:e20154089 Metformin or Oral Contraceptives for Adolescents With Polycystic Ovarian Syndrome: A Meta-analysis Reem A. Al Khalifah, MD, FRCPC, MSc, a,b,c Ivan D. Florez, MD, MSc, b,d Brittany Dennis, PhD, b,e Lehana Thabane, PhD, b,f Ereny Bassilious, MD, FRCPC, MHPE a abstract BACKGROUND: Polycystic ovarian syndrome (PCOS) is a common disease. There is limited evidence to support various treatment choices. This leads to variable treatment practices. OBJECTIVES: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the use of metformin versus oral contraceptive pills (OCPs) for the treatment of PCOS in adolescents aged 11 to 19 years. DATA SOURCES: We performed literature searches through Ovid Medline, Ovid Embase, Cochrane Central Register of Controlled Trials, and gray literature resources, up to January 29, 2015. STUDY SELECTION AND DATA EXTRACTION: Two reviewers screened titles and abstracts of identified citations, assessed full text eligibility, and extracted information from eligible trials. RESULTS: Four RCTs met the inclusion and exclusion criteria. The reviewed evidence came from 170 patients. Overall, OCP treatment resulted in modest improvement in menstrual cycle frequency (weighted mean difference [WMD] = 0.27, P < .01, 95% confidence interval [CI] −0.33 to −0.21) and mild reduction of acne scores (WMD = 0.3, P = .02, 95% CI 0.05 to 0.55). While metformin resulted in greater BMI reduction (WMD = −4.02, P < .01, 95% CI −5.23 to −2.81) it was associated with decreased dysglycemia prevalence (risk ratio: 0.41, P = .02, 95% CI 0.19 to 0.86) and improved total cholesterol and low-density lipoprotein levels. Metformin and OCPs were similar in terms of impact on hirsutism. CONCLUSIONS AND LIMITATIONS: Current evidence is derived from very low to low quality evidence. Therefore, treatment choice should be guided by patient values and preferences while balancing potential side effects. Future high quality RCTs are needed to address several questions for the treatment of adolescents with PCOS. a Division of Endocrinology and Metabolism, Department of Pediatrics, Departments of b Clinical Epidemiology and Biostatistics, f Pediatrics and Anesthesia, McMaster University, Hamilton, Canada; c Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia; d Department of Pediatrics, Universidad de Antioquia, Colombia; and e St. George’s University of London, Cranmer Terrace, London, United Kingdom Dr Al Khalifah conceptualized and designed the study, and drafted and critically reviewed the manuscript; Dr Florez conceptualized and designed the study and critically reviewed the manuscript; Dr Dennis designed the study and drafted and critically reviewed the manuscript; Dr Thabane designed the study and critically reviewed the manuscript; Dr Bassilious conceptualized the study, designed the study, and critically reviewed the manuscript; and all authors approved the final manuscript as submitted. This systematic review has been registered with PROSPERO (CRD42015020922). DOI: 10.1542/peds.2015-4089 To cite: Al Khalifah RA, Florez ID, Dennis B, et al. Metformin or Oral Contraceptives for Adolescents With Polycystic Ovarian Syndrome: A Meta-analysis. Pediatrics. 2016;137(5):e20154089 by guest on May 18, 2016 Downloaded from