N - a c e t y l c y s t e i n e v e r s u s
M e t f o r m i n i n t r e a t m e n t o f
P C O S
M Fahmy, H Abdelkader, K I...
NAC
Acetylated variant of the amino acid L-cysteine
Mechanisms of action
The beneficial effects of NAC are a result of its...
Effects
A. Metabolic:
1. Antioxidant:
in non-insulin dependent DM (1.2 gm for 1 month)
(De Mattia, et al., 1998).
preserve...
B. Biological effects:
Antiapoptotic
(Odetti et al., 2003).
Anticytokines (inhibit proinflammatory cytokine release)
(Lapp...
To compare the effect of NAC & Metformin on:
• hormonal profile (insulin & testosterone)
• ovulation rate
in CC resistant ...
60 infertile women with CC resistant PCOS (CC 100 mg/day for
at least 3 cycles).
Inclusion criteria:
1. Age: between 19-35...
Patients were randomly assigned into 2 groups each
consisting of 30 patients.
Group I: Metformin (Cidophage tablet, CID, S...
Folliculometry was done by serial TVS every other
day from D10 of the cycle.
After 6 weeks the above investigations (fasti...
Variable
Metformin
(n= 30)
NAC
(n=30)
P value
Age (Ys)
Range 19:35 20:33
0.736
Mean + SD 26.73 + 5.36 27.33 + 3.35
Duratio...
Variable Metformin
(n=30)
NAC
(n=30)
P value
Fasting glucose
(mg/dl)
Range 85:120 75:110 0.07
Mean
±SD
105.93±11.4 91.67±1...
Variable
Metformin
(n=30)
NAC
(n=30)
Before After
P
valu
e
Before After
P
value
Fasting
glucose
mg/dl
Range 85:120 69:102
...
Fasting
glucose/
fasting
insulin
< 4.5
Metformin
(n=30)
NAC
(n=30)
Before After
z-
test
P-
value
Before After
z-
test
P-
v...
Metformin
(n=30)
NAC
(n=30)
16 2
Ovulation
rate
53.3% 6.6%
Z-test 2.02*
P-value 0.004
Ovulation rate in both groups.
ABOUB...
Metformin alone is effective drug in inducing
ovulation in CC resistant PCOS while NAC
alone is not.
Further large studies...
ABOUBAKR ELNASHAR
of 15

N-acetyl cysteine versus Metformin in treatment of PCOS

N-acetyl cysteine versus Metformin in treatment of PCOS
Published on: Mar 3, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - N-acetyl cysteine versus Metformin in treatment of PCOS

  • 1. N - a c e t y l c y s t e i n e v e r s u s M e t f o r m i n i n t r e a t m e n t o f P C O S M Fahmy, H Abdelkader, K Ibraheim ABOUBAKR ELNASHAR
  • 2. NAC Acetylated variant of the amino acid L-cysteine Mechanisms of action The beneficial effects of NAC are a result of its ability to 1. Reduce extra-cellular cystine to cysteine 2. Be a source of SH groups: so stimulate glutathione synthesis, enhance glutathione-s-transferase activity, promote detoxification, and act directly on reactive oxidant radicals (De Vries et al., 1993). ABOUBAKR ELNASHAR
  • 3. Effects A. Metabolic: 1. Antioxidant: in non-insulin dependent DM (1.2 gm for 1 month) (De Mattia, et al., 1998). preserve vascular integrity (Sekhon et al. 2003) protect against focal ischemia. 2. Insulin sensitizer: Increase peripheral insulin sensitivity, whereas the hepatic insulin extraction was unaffected (Moghetti et al., 2000). ABOUBAKR ELNASHAR
  • 4. B. Biological effects: Antiapoptotic (Odetti et al., 2003). Anticytokines (inhibit proinflammatory cytokine release) (Lappas et al. 2003) Inhibition of phosopholipid metabolism& Protease activity. NAC may exert the same effects at the ovarian level which may be important in inducing ovulation Mucolytic. ABOUBAKR ELNASHAR
  • 5. To compare the effect of NAC & Metformin on: • hormonal profile (insulin & testosterone) • ovulation rate in CC resistant PCOS ABOUBAKR ELNASHAR
  • 6. 60 infertile women with CC resistant PCOS (CC 100 mg/day for at least 3 cycles). Inclusion criteria: 1. Age: between 19-35 years 2. Duration of infertility > 2 years. 3. Patent tubes and normal uterine cavity documented by a recent HSG and a recent (within 3 months) 4. Normal semen parameters according to WHO criteria (1993). 5. No treatment was taken during the last 2 months. ABOUBAKR ELNASHAR
  • 7. Patients were randomly assigned into 2 groups each consisting of 30 patients. Group I: Metformin (Cidophage tablet, CID, SAE) 1500 mg/day.(500 mg/ tablet) from the first day of the cycle, for 6 weeks Group II: Acetyl cysteine (SEDICO, SAE) (200 mg /sachet) 1.8 gm (on 3 divided doses) from the first day of cycle, for 6 weeks. ABOUBAKR ELNASHAR
  • 8. Folliculometry was done by serial TVS every other day from D10 of the cycle. After 6 weeks the above investigations (fasting glucose, fasting insulin, total testosterone) were repeated. • HOMA-IR= FI (uU/ml) X FG (mmol/L)/22.5 <3.2 insulin resistance • FG (mg/dl)/FI (uU/ml) <4.5 insulin resistance ABOUBAKR ELNASHAR
  • 9. Variable Metformin (n= 30) NAC (n=30) P value Age (Ys) Range 19:35 20:33 0.736 Mean + SD 26.73 + 5.36 27.33 + 3.35 Duration of Infertility (Ys) Range 2:10 3:7 0.866 Mean + SD 5.07 + 2.60 5.07 + 1.47 Body mass index (kg/m² Range 27:32 27:30 0.683 Mean + SD 28.8 + 1.52 28.8 + 0.94 Waist / hip ratio Range 0.70:0.96 0.78:0.90 0.257 Mean + SD 0.81 + 0.07 0.83 + 0.04 Waist circumference >100 cm 8 10 0.635 <100cm 22 20 0.575 Menstrual pattern Oligomenorrhea 73.4% 80 0.366Regular menses 20% 6.7% Irregular menses 6.7% 13.3 Hirsutism Present 86.7% 66.7% 0.195 Absent 13.3% 33.3% Clinical characteristics of patients in both groups before treatment. ABOUBAKR ELNASHAR
  • 10. Variable Metformin (n=30) NAC (n=30) P value Fasting glucose (mg/dl) Range 85:120 75:110 0.07 Mean ±SD 105.93±11.4 91.67±11.3 Fasting insulin (IU/ml) Range 10:22 10:75 0.17 Mean ± SD 17.7±3.1 26.87±19.65 Fasting glucose/fasting insulin Range 3.8: 11 1.1: 10.8 0.32 Mean ± SD 6.47± 1.80 4.77±2.59 HOMA-IR Range 2.7: 5.33 1.9: 6.1 0.24 Mean ± SD 4.3 ±1.17 4.53±1.9 Total testosterone (pg/ml) Range 49: 164 45:161 0.07 Mean ±SD 116.47±44.67 84.60±27.76 Hormonal profile of both groups before treatment. ABOUBAKR ELNASHAR
  • 11. Variable Metformin (n=30) NAC (n=30) Before After P valu e Before After P value Fasting glucose mg/dl Range 85:120 69:102 0.001 75:110 68:100 0.008Mean + SD 105.93 + 11.4 91.87 + 12.35 91.67 + 11.3 86 + 9.75 Fasting insulin IU/ml Range 10:22 8:18 0.004 10:75 8:55 0.002Mean + SD 17.7 + 3.1 14.53 + 2.8 26.87 + 19.65 21 + 11.5 Fasting glucose/fasting insulin Range 3.8:11 4:12.6 0.31 1.1:10.8 1.40:11.1 0.208Mean + SD 6.47 + 1.80 6.58 + 2.26 4.77 + 2.59 5.19 + 2.74 Total testosterone Pg/ml Range 49:164 43:130 0.001 45:161 40:150 0.001Mean + SD 116.47 + 44.67 88.27 + 31.56 48.60 + 27.76 73.87 + 17.49 Effects of metformin & NAC on hormonal profile ABOUBAKR ELNASHAR
  • 12. Fasting glucose/ fasting insulin < 4.5 Metformin (n=30) NAC (n=30) Before After z- test P- value Before After z- test P- value 18 3 2.83 0.01 16 10 1.21 0.22 > 4.5 12 12 2.12 0.03 14 20 1.05 0.29 HOMA-IR < 3.2 2 6 1.33 0.18 4 8 1.53 0.12 > 3.2 28 24 1.52 0.17 26 22 1.47 0.11 Effect of metformin & NAC on fasting glucose/fasting insulin ratio & HOMA-IR ABOUBAKR ELNASHAR
  • 13. Metformin (n=30) NAC (n=30) 16 2 Ovulation rate 53.3% 6.6% Z-test 2.02* P-value 0.004 Ovulation rate in both groups. ABOUBAKR ELNASHAR
  • 14. Metformin alone is effective drug in inducing ovulation in CC resistant PCOS while NAC alone is not. Further large studies are required to confirm our results. ABOUBAKR ELNASHAR
  • 15. ABOUBAKR ELNASHAR

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