Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting about 10% of women in reproductive age and associated with a variety of hormonal abnormalities, including hyperandrogenemia and infertility, all of which could lead to PCOS. Statins were previously introduced as a therapeutic option for reducing testosterone levels in women with PCOS, either alone or in combination. The aim of this study is to evaluate the effectiveness of different statins alone or in combination with metformin in reducing testosterone levels in women with PCOS. Medline, Embase, and clinicaltrials.gov were searched for studies that investigated the efficacy of statins, metformin, spironolactone, or combined oral contraceptives (COCs), individually or in combination, in reducing the testosterone level in patients with PCOS. The search was limited to randomized clinical trials and conducted according to the preferred reporting items for systematic reviews and meta-analyses - extension statement for network meta-analyses (PRISMA-NMA). The quality of included studies was assessed using the Cochrane Collaboration risk of bias (RoB) assessment tool. A frequentist network meta-analysis using random-effects models was used to assess the efficacy in reducing testosterone level and were expressed as odds ratios (OR) and 95% credible interval (95%Crl). All statistical analyses were performed using netmeta Version 1.0 on R statistical package. Nine RCTs involving 613 patients were included. Atorvastatin showed greater reduction in testosterone level compared to COC (MD −2.78, 95%CrI −3.60, −1.97), spironolactone plus metformin (MD −2.83, 95%CrI −3.80, −1.87), simvastatin (MD −2.88, 95%CrI −3.85, −1.92), spironolactone (MD −2.90, 95%CI −3.77, −2.02), simvastatin plus metformin (MD −2.93, 95%CrI −3.79, −2.06), metformin (MD −2.97, 95%CrI −3.69, −2.25), lifestyle modification (MD −3.02, 95%CrI −3.87, −2.18), and placebo (MD −3.04, 95%CrI −3.56, −2.53). Atorvastatin was found to be more effective than the other management strategies in reducing the total testosterone level for patients with PCOS. Future studies should focus on the optimal dose.

中文翻译：

---

他汀类药物，二甲双胍，螺内酯和联合口服避孕药在降低多囊卵巢综合征女性睾丸激素水平方面的比较功效：一项随机临床试验的网络荟萃分析。

多囊卵巢综合征（PCOS）是一种内分泌失调，可影响约10％育龄妇女，并伴有多种激素异常，包括高雄激素血症和不育症，所有这些均可导致PCOS。先前曾将他汀类药物作为降低PCOS妇女睾丸激素水平的治疗选择，无论是单独使用还是联合使用。这项研究的目的是评估单独的他汀类药物或与二甲双胍联用降低PCOS妇女睾丸激素水平的有效性。检索Medline，Embase和Clinicaltrials.gov，以研究他汀类，二甲双胍，螺内酯或联合口服避孕药（COC）单独或组合在降低PCOS患者睾丸激素水平方面的功效。搜索仅限于随机临床试验，并根据系统评价和荟萃分析的首选报告项目进行-网络荟萃分析的扩展声明（PRISMA-NMA）。使用Cochrane协作偏倚风险（RoB）评估工具评估了纳入研究的质量。使用随机效应模型的频繁网络荟萃分析用于评估降低睾丸激素水平的功效，并表示为比值比（OR）和95％可信区间（95％Crl）。所有统计分析均使用R统计软件包上的netmeta版本1.0进行。包括613名患者的9个RCT。与COC（MD -2.78，95％CrI -3.60，-1.97），螺内酯加二甲双胍（MD -2.83，95％CrI -3.80，-1.87）相比，阿托伐他汀显示出更大的睾丸激素水平降低，辛伐他汀（MD -2.88，95％CrI -3.85，-1.92），螺内酯（MD -2.90，95％CI -3.77，-2.02），辛伐他汀加二甲双胍（MD -2.93，95％CrI -3.79，-2.06），二甲双胍（MD -2.97，95％CrI -3.69，-2.25），生活方式改变（MD -3.02，95％CrI -3.87，-2.18）和安慰剂（MD -3.04，95％CrI -3.56，-2.53）。发现阿托伐他汀在降低PCOS患者总睾丸激素水平方面比其他管理策略更有效。未来的研究应集中在最佳剂量上。发现阿托伐他汀在降低PCOS患者总睾丸激素水平方面比其他管理策略更有效。未来的研究应集中在最佳剂量上。发现阿托伐他汀在降低PCOS患者总睾丸激素水平方面比其他管理策略更有效。未来的研究应集中在最佳剂量上。