Exploring new treatment options for polycystic ovary syndrome: Review of a novel antidiabetic agent SGLT2 inhibitor

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age associated with long-term metabolic and cardiovascular consequences. A plethora of symptoms and their severity differentiate on an individual level, giving the syndrome numerous phenotypes. Due to menstrual cycle abnormalities, women suffer from irregular menstrual bleeding, difficulty in conception, and infertility. Furthermore, the risk of pregnancy complications such as gestational diabetes mellitus, hypertensive disorders of pregnancy, and preterm birth are higher in women with PCOS than in the general population. Often, women with PCOS have comorbidities such as dyslipidemia, obesity, glucose intolerance or diabetes type 2, non-alcoholic fatty liver disease, and metabolic syndrome, which all influence the treatment plan. Historic insulin-sensitizing agents, although good for some of the metabolic derangements, do not offer long-term cardiovascular benefits; therefore, new treatment options are of paramount importance. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors, a new class of antidiabetic agents with beneficial cardiovascular, bodyweight, and antihyperglycemic effects, although not approved for the treatment of PCOS, might be an attractive therapeutic addition in the PCOS armamentarium. Namely, recent studies with SGLT-2 inhibitors showed promising improvements in anthropometric parameters and body composition in patients with PCOS. It is important to further explore the SGLT-2 inhibitors potential as an early therapeutic option because of the PCOS-related risk of metabolic, reproductive, and psychological consequences.

Keywords: Polycystic ovary syndrome; Sodium-glucose co-transporter-2 inhibitors; Metabolic risk; Cardiovascular risk; Metabolic syndrome; Insulin resistance; Obesity; Type 2 diabetes mellitus; Dyslipidemia

Core Tip: Sodium-glucose co-transporter-2 (SGLT-2) inhibitors are a new class of antidiabetic agents with beneficial cardiovascular, bodyweight, and antihyperglycemic effects. Although not approved for the treatment of polycystic ovary syndrome (PCOS), they might be an attractive therapeutic addition for the related metabolic, reproductive, and psychological consequences. Recent studies with SGLT-2 inhibitors in PCOS patients showed promising improvements in anthropometric parameters and body composition. Thus, it is important to explore the SGLT-2 inhibitors potential as an early therapeutic option in PCOS due to its high cardiometabolic risk.