Impact of Metformin in Teens With Polycystic Ovary Syndrome (PCOS) on Oral Contraceptive Therapy

Official Title: “Metabolic Impact of Oral Contraceptives With or Without Metformin in Obese Adolescents With Polycystic Ovary Syndrome (PCOS)”

Oral contraceptives are known to improve menstrual cycles and symptoms in PCOS, however may increase cholesterol. Metformin, a drug to improve insulin resistance, may benefit metabolic state. This study is to determine whether metformin added to oral contraceptive therapy in adolescent women with PCOS improves metabolic state.The study will also test a lifestyle improvement program to reduce weight.

Polycystic Ovary Syndrome (PCOS) is a heterogeneous condition characterized by chronic anovulation and androgen excess that occurs in 4-8% of unselected adult women. Although signs and symptoms of the disorder typically appear at the time of puberty, diagnosis is often delayed until adulthood. At least 50% of adult women with PCOS are obese, resulting in a more severe clinical picture. Obesity among adolescents has been increasing in recent years, with overrepresentation of females who show evidence of hyperandrogenism and irregular periods, suggesting an association of obesity and PCOS at an early age. Recent data, however, have drawn attention to the long-term risks of PCOS, including diabetes and cardiovascular disease. Insulin resistance plays a critical role in the pathophysiology of PCOS and is thought to be the metabolic abnormality most closely linked to an increased risk of diabetes and heart disease. Traditional treatments with oral contraceptives are associated with reduction in serum androgens and improvements in menstrual cycles in adolescents with PCOS, however these have not been well-studied in obese adolescents. Oral contraceptives may worsen the dyslipidemia seen in obese women with PCOS and do not address the insulin resistance. Metformin, an insulin sensitizing agent, has been shown to improve metabolic features of PCOS, but combination therapy with oral contraceptives has never been studied in the obese adolescent with PCOS.

The major hypothesis of this proposal is that metformin will improve the metabolic profile of obese adolescent girls with PCOS treated with oral contraceptives. Additionally, a secondary hypothesis will be that compliance with a concurrent lifestyle modification program with be associated with the most significant improvements.

Intervention(s) in this Clinical Trial

• Drug: Metformin
  • Metformin 500 mg. tabs 2 tabs BID for duration of study
• Drug: Oral Contraceptive Pill
  • Yasmin, drospirenone and ethinyl estradiol 28 tablets 1 tab daily for duration of study
• Behavioral: Lifestyle Management Program
  • Subjects and a parent/guardian will participate in a series of classes for training in diet, exercise & behavior modification skills on a regular weekly basis over the 24 week study
• Behavioral: Quality of Life Questionnaire
  • Quality of Life questionnaire designed for women with Polycystic Ovary Syndrome. Questions concern health and health related issues Performed twice during study, at baseline and conclusion
• Procedure: Oral Glucose Tolerance Test
  • Insulin response to a glucose challenge in an oral glucose tolerance test (OGTT), as measured by area under the curve (AUC). In this study we will administer an OGTT and calculate the AUC as a measure of insulin resistance. Performed twice during study, at baseline and conclusion
• Procedure: Blood work
  • Initial and conclusion blood draws include; comprehensive metabolic profile, CBC and platelet,hormonal assessment and lipids.
• Procedure: Abdominal Ultra Sound
  • transabdominal transducer, which contains integrated software for volume calculation will be used to assess ovarian volume. Performed twice during study, at baseline and conclusion
• Procedure: Dual-energy x-ray absorptiometry (DEXA scan)
  • Dual-energy x-ray absorptiometry (DEXA) will be used to assess percent body fat Performed twice during study, at baseline and conclusion
• Drug: placebo
  • placebo capsules, two capsules BID

Arms, Groups and Cohorts in this Clinical Trial

• Active Comparator: 1
  • metformin
• Placebo Comparator: 0
  • placebo

Primary Measures

• Reduction in Abdominal Fat as Measured by Waist Circumference.
  • Time Frame: baseline and 24 weeks
    Safety Issue?: No

Secondary Measures

• Change in Weight Post Minus Pre Intervention.
  • Time Frame: baseline and 24 weeks
    Safety Issue?: No
• Total Testosterone Change
  • Time Frame: baseline and 24 weeks
    Safety Issue?: No
• Change in Sex Hormone Binding Globulin (SHBG)
  • Time Frame: baseline and 24 weeks
    Safety Issue?: No

• Inclusion Criteria:Age 12-18 years; Menstrual irregularity; Overweight; Must be able to swallow capsules; At lease 6 months since onset of first menstrual cycle.
• Exclusion Criteria:Diabetes; Kidney or Liver disease; Tobacco use; Depression or Bipolar
• Disease; Contraindication to exercise; Weight > 300 lbs.

Gender Eligibility for this Clinical Trial: Female

Minimum Age for this Clinical Trial: 12 Years

Maximum Age for this Clinical Trial: 18 Years

Are Healthy Volunteers Accepted for this Clinical Trial?: Accepts Healthy Volunteers

Lead Investigator: University of Rochester Other

Overall Clinical Trial Officials and Contacts

Kathleen Hoeger, MD Principal Investigator University of Rochester  

Information obtained from ClinicalTrials.gov on February 12, 2012

Link to the current ClinicalTrials.gov record. http://clinicaltrials.gov/show/NCT00283816

Study ID Number: RSRB-00012501

ClinicalTrials.gov Identifier: NCT00283816

Health Authority: United States: Food and Drug Administration