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Bibliographic details: Du Q, Yang S, Wu B, Han P.  Rosiglitazone versus metformin for polycystic ovary syndrome: a systematic review. Chinese Journal of Evidence-Based Medicine 2011; 11(9): 1021-1026 Available from: http://www.cjebm.org.cn/oa/DArticle.aspx?type=view&id=201109008

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

The aim of this review was to evaluate the use of pioglitazone and rosiglitazone, in terms of both clinical and cost-effectiveness in the treatment of type 2 diabetes.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2004

Metformin is a biguanide oral hypoglycemic used primarily for treating type 2 diabetes mellitus (T2D). Evidence suggests that, in addition to improving glycemic control, metformin is associated with improved all-cause and cardiovascular mortality and decreased risk of some cancers. However, clinicians have been advised by the U.S. Food and Drug Administration (FDA) to exercise caution in prescribing metformin to individuals with chronic kidney disease (CKD), unstable congestive heart failure (CHF), chronic liver disease (CLD), and older age due to perceived risk of side effects, including lactic acidosis (LA).

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: September 2016

Diabetes is a chronic, metabolic disease with significant health impacts on individuals and societies. The prevalence of diabetes in Canada was 6.8% (2.4 million Canadians) in 2009 and is expected to rise to 3.7 million people by 2019. Ninety per cent of people with diabetes have type 2 diabetes mellitus (T2DM). T2DM is characterized by increased hepatic glucose output, reduced insulin secretion, and insulin resistance. People with diabetes are at risk of microvascular complications such as diabetic nephropathy and retinopathy, macrovascular complications such as cardiovascular disease, and premature mortality. Improved glycemic control reduces the risk of microvascular complications, and possibly of macrovascular complications. Current guideline recommendations specify a target for glycated hemoglobin (A1C) of 7% or less for most patients with T2DM.

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: August 2015

Saxagliptin (Onglyza) is an oral antihyperglycemic agent belonging to the dipeptidyl peptidase-4 (DPP-4) inhibitor class. Saxagliptin is indicated for patients with type 2 diabetes mellitus to improve glycemic control in combination with metformin, a sulfonylurea, metformin and a sulfonylurea, or long- or intermediate-acting insulin (with or without metformin), when these drugs do not provide adequate glycemic control. The recommended dose of saxagliptin is 5 mg once daily for most patients and 2.5 mg once daily for patients with moderate or severe renal impairment (creatinine clearance [CrCl] ≤ 50 mL/min).

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: November 2013

OBJECTIVES: To evaluate the use of pioglitazone and rosiglitazone, in terms of both clinical and cost-effectiveness in the treatment of type 2 diabetes.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Women with polycystic ovary syndrome suffer from excessive hairiness (hirsutism), irregular periods, and acne. They are also at greater risk of developing diabetes, cardiovascular disease, and endometrial cancer.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 24, 2007

The aims of this research were the comparative benefit assessments of long-term treatment with pioglitazone or rosiglitazone vs. placebo, pioglitazone or rosiglitazone vs. another glucose-lowering drug or non-drug intervention, pioglitazone vs. rosiglitazone, in each case as monotherapy or in combination with another glucose-lowering therapy, in patients with diabetes mellitus type 2 treated within the framework of the valid drug approval criteria.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 26, 2008

Researchers reviewed the evidence about the effectiveness and safety of metformin and other drugs that improve the body's sensitivity to insulin, for inducing ovulation in women with polycystic ovary syndrome (PCOS). Of interest were live birth rate, adverse effects and additional reproductive and metabolic outcomes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2018

BACKGROUND: Polycystic ovarian syndrome (PCOS) leads to a multitude of clinical and biochemical alterations in patients. Metformin and the thiazolidenediones (TZDs)--which have insulin-sensitizing properties--are believed to be effective in minimizing the changes caused by this syndrome.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

How do newer drugs for diabetes compare in lowering blood sugar levels?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: May 16, 2011

The authors concluded that rosiglitazone appeared to be safe with respect to the risk of incidence of cancer, but that further studies were needed to confirm a possible protective effect. Given potential for bias in the review, issues with the statistical analysis and uncertain quality of the included studies, the authors' conclusion should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

This review of randomised trials concluded that rosiglitazone use for at least 12 months is associated with a significantly increased risk of myocardial infarction and heart failure, but not cardiovascular mortality, in patients with impaired glucose tolerance or type 2 diabetes. These conclusions appear appropriate given the evidence presented.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

This review assessed the cardiovascular risk of rosiglitazone and found it to be associated with increased risk of heart failure, but not increased risk of myocardial infarction or cardiovascular mortality. Issues with potential publication bias and study quality mean that the authors' conclusion should be interpreted with some caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

This review, which included a very large number of patients, concluded that rosiglitazone treatment increased the risk of myocardial infarction, but not of cardiovascular or all-cause mortality, compared with placebo or alternative interventions. Despite a lack of validity assessment and poor reporting of some aspects of the review process, this conclusion is probably reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

This review concluded that metformin, administered before pregnancy, had no effect on the abortion risk in women with a diagnosis of polycystic ovary syndrome. There was considerable variation between the included trials in their treatment protocols, comparators, cointerventions, and fertility treatments. This and some limitations in the analysis mean that the authors' conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

This review of that adding sulphonylureas to the treatment of patients with type 2 diabetes not controlled by metformin would reduce glycated haemoglobin by no more than 1% and may increase side-effects. Despite poor reporting of some aspects of the review process, the conclusions reflected the results of the review and appear likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

This review concluded that different antidiabetic agents in combination with metformin had similar effects in reducing glycated haemoglobin levels in type 2 diabetes patients, previously treated with metformin monotherapy. This was a well-conducted review; the conclusions reflect the evidence shown, but limitations of the evidence base mean that the recommendation for further research is warranted.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

This review concluded that the evidence seemed to exclude any overall harmful effect of metformin on cardiovascular risk and suggested a possible benefit versus placebo/no treatment. Limitations with the included evidence and a lack of reporting of some aspects of the review process limit the reliability and generalisability of the results. The cautious conclusion and recommendations for research seem appropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

The review found that there was insufficient evidence to determine whether metformin or thiazolidinediones were superior for the treatment of polycystic ovary syndrome. Considering the poor quality of included trials and substantial variation, the authors' cautious conclusions are appropriate and likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

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