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Lifestyle changes plus the weight-loss drug orlistat (Xenical) helped women with polycystic ovarian syndrome (PCOS) shed pounds, leading to metabolic improvements, researchers found.
In a controlled trial, women with and without PCOS lost a comparable percentage of body weight using the drug in combination with dietary changes and increased exercise (12.9% and 14.9%), , of AHEPA Hospital in Thessaloniki in Greece, and colleagues .
Action Points
- Lifestyle changes plus the weight-loss drug helped women with shed pounds, leading to metabolic improvements.
- The study suggests that orlistat in combination with changes in diet and exercise is associated with greater weight loss than orlistat alone in obese women with PCOS.
Women with PCOS also saw improvements in blood pressure, cholesterol, and markers of insulin resistance, they reported.
"Orlistat combined with lifestyle changes induces substantial weight loss in women with PCOS, resulting in improvements in insulin resistance and hyperandrogenemia," as well as "beneficial effects on other established cardiovascular risk factors," they wrote.
Obesity is common in women with PCOS, but there are limited data on the effects of weight-loss drugs in the condition.
So Tziomalos and colleagues studied 101 obese and overweight women with PCOS (mean age 26, BMI 34.5 kg/m2), and compared them with 29 matched controls with normal ovulating cycles during a 6-month follow-up period.
All of the women followed a low-calorie diet, were instructed to exercise, and were treated with 120 mg orlistat three times a day for the entire study.
The researchers found a significant and comparable reduction in weight and in body mass index (BMI) in women with PCOS and controls. Mean weight loss was 12.9% for those with PCOS and 14.9% for controls, and change in BMI was significant at P<0.001 for both groups.
Systolic and diastolic blood pressure fell only among women with PCOS (P<0.001 for both) and didn't change in controls.
They also found that total cholesterol and LDL cholesterol levels fell in both groups (P<0.001 and P=0.001, respectively), although the reduction was greater in controls.
Serum HDL cholesterol levels, however, didn't change for women with PCOS, and they decreased significantly in controls (P=0.006).
Serum triglycerides fell significantly and to a comparable degree in both groups, as did several markers of insulin resistance, including HOMA-IR and QUICKI.
But serum glucose levels under the oral glucose tolerance test (OGTT) curve fell in women with PCOS, without changing among controls, the researchers reported.
Testosterone levels and the free androgen index (FAI) also decreased significantly in women with PCOS without changing among controls.
And the prevalence of the metabolic syndrome fell for both groups, from 43.2% to 19.7% for PCOS patients, and from 52.4% to 26.1% in controls.
Tziomalos and colleagues concluded that orlistat in combination with changes in diet and exercise "appears to induce considerably greater weight loss than orlistat alone in obese women with PCOS" when taking into account findings from previous studies.
They said it remains to be seen whether the weight loss and its beneficial metabolic effects will ultimately translate to a lower risk of type 2 diabetes and cardiovascular disease in such a high-risk population.
Disclosures
The researchers reported no conflicts of interest.
Primary Source
Clinical Endocrinology
Panidis D, et al "The role of orlistat combined with lifestyle changes in the management of overweight and obese patients with polycystic ovary syndrome" Clinical Endocrinol 2013; DOI: 10.1111/cen.12305.