Inositol With Metformin Versus Metformin Monotherapy in Polycystic Ovary Syndrome: A Meta‐Analysis of Randomised Controlled Trials

ABSTRACT Background The effectiveness of the combination of metformin and inositol versus metformin on clinical and laboratory results in patients with polycystic ovary syndrome (PCOS) is not well known. Objectives We aimed to compare the use of inositol with metformin versus metformin in patients with PCOS. Search Strategy PubMed, Embase, and Cochrane databases were searched from inception to January 2024. Selection Criteria Randomised controlled trials (RCTs). Data Collection and Analysis Statistical analyses were performed using R Studio 4.3.2. Risk ratios (RR) and mean difference (MD) with 95% CI were pooled across trials. The primary outcomes were regular menstrual cycle, homoeostasis model assessment for insulin resistance (HOMA‐IR), global acne score (GAS) and body mass index (BMI). Main Results Five RCTs reporting data on 351 patients were included. One hundred seventy‐five patients (49.8%) received inositol with metformin. Follow‐up ranged from 3 to 6 months. The regularity of the menstrual cycle (RR 1.85; 95% CI 1.17–1.92) was significantly higher in patients treated with inositol and metformin compared to metformin. HOMA‐IR (MD −0.17; 95% CI −0.35 to 0.01), GAS (MD −0.81; 95% CI −2.07 to 0.44), and BMI (MD 1.09; 95% CI −0.39 to 2.57) were not significantly different among groups. Conclusion In patients with PCOS, the combination of metformin and inositol was associated with a higher rate of menstrual cycle regularisation.