Presentation summary

Background :
To conduct a network meta-analysis (NMA) comparing the effectiveness and safety of traditional acupuncture with metformin measured using the Homeostasis Model Assessment Insulin Resistance (HOMA-IR) index, fasting plasma glucose, fasting insulin, and the incidence of adverse events (AEs), aiming to identify an effective and safe alternative treatment for women with polycystic ovary syndrome (PCOS) complicated byinsulin resistance (IR).

Methods :
We searched PubMed, EMBASE, Web of Science, Cochrane, ClinicalTrials.gov, and relevant citations for eligible randomized controlled trials (RCTs) published up to August 12, 2024. Data extraction andbias assessment were performed by two independent reviewers, and Bayesian NMA was performed using theGeMTC package, with a random effects model.

Results :
We included twelve RCTs (n=870). Four RCTs compared acupuncture with metformin, six compared metformin with control interventions (blank control or placebo), and two compared acupuncture with shamacupuncture. Acupuncture (Mean difference (MD): -0.76, 95% credible interval [CrI]: -1.42, -0.03) andmetformin (MD: -0.74, 95%CrI: -1.28, -0.17) significantly reduced the IR level (HOMA-IR). No statistical difference was observed between both treatment methods in improving glucose metabolism; however,acupuncture had fewer AEs (risk ratio: 0.13, 95%CrI: 0.01,0.68). Acupuncture all ranked high in terms of surface under the cumulative ranking curve across all outcomes, thus demonstrating better effectiveness and safety potential.

Conclusions :
Acupuncture may be a potential alternative for PCOS women with IR, as it is equally effective,easier to perform, and relatively safer than metformin. Further trials are necessary to confirm these finding sowing to the current lack of sufficient evidence.

Key words : Polycystic ovary syndrome, insulin resistance, acupuncture, metformin, metabolism.