Comparison of the Effects of Cyproterone Compound-Spironolactone, Metformin and Pioglitazone on Serum Levels of High Sensitivity C-Reactive Protein and Complement System in Polycystic Ovarian Syndrome: A Randomized Double-blind Clinical Trial

Abstract

Introduction: Polycystic ovarian syndrome (PCOS) is one of the most common hormonal disorders affecting women of reproductive age. Numerous studies have suggested the involvement of inflammation in the pathogenesis of PCOS. As a result, drugs with anti-inflammatory effects may offer therapeutic benefits for this condition. The standard medications used in treating PCOS include cyproterone compound (cyproterone acetate + ethinyl estradiol) combined with spironolactone, metformin, and pioglitazone. This study aimed to compare the effects of these drugs on the serum levels of inflammatory markers, including hs-CRP, C3, and C4, in women with PCOS.Materials and methodsNinety women with PCOS were randomly assigned to three treatment groups for 90 days as follows: Group CC-SP received cyproterone compound (cyproterone acetate 2 mg + ethinyl estradiol 35 µg) daily, along with 100 mg/day spironolactone; Group M received metformin (1500 mg/day); and Group P received pioglitazone (30 mg/day). Serum levels of hs-CRP, C3, and C4 were measured before and after treatment.Comparisons of changes in variables between groups were performed using the ANOVA test. Additionally, covariance (ANCOVA) analysis was used to examine differences between groups, adjusting for confounding variables. Probability values of ≤ 0.05 were considered statistically significant.ResultsThe C3, C4, and hs-CRP levels were increased in the CC-SP group while significantly decreased in the pioglitazone group (p<0.05). These changes were not statistically significant in the metformin group.ConclusionsPioglitazone reduces the serum levels of inflammatory markers and may be effectively combined with cyproterone and spironolactone in the treatment of PCOS.

Keywords

• polycystic ovarian syndrome
• inflammation
• cyproterone
• spironolactone
• metformin
• pioglitazone