Impact of Metformin Therapy on Chronic Inflammatory Markers Serum Fractalkine and CRP Levels in Polycystic Ovary Syndrome: A Pilot Study on Chronic Inflammatory Markers and Clinical Outcomes.

Abstract

Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, with a prevalence of 8-13% depending on diagnostic criteria. Its pathophysiology is linked to insulin resistance and resulting chronic inflammation. This study compares serum levels of fractalkine and high-sensitivity C-reactive protein (hs-CRP), markers of chronic inflammation, in PCOS patients before and after metformin therapy.

Materials and methods: Thirty women with PCOS were recruited from gynecology and dermatology OPDs. Their serum fractalkine and hs-CRP levels were measured before starting metformin. The patients were then administered metformin, beginning with 500 mg once daily and increasing to 500 mg three times daily over four months, followed by repeat measurements of serum fractalkine and hs-CRP.

Results: Post-metformin therapy, a significant reduction in serum fractalkine levels was observed (from 0.52 ± 0.29 to 0.38 ± 0.21 ng/ml, p = 0.001). Similarly, hs-CRP levels decreased significantly (from 0.71 ± 0.37 to 0.58 ± 0.27 ng/ml, p = 0.016). Clinical improvements in hirsutism, acne, acanthosis, and BMI were also noted, alongside a significant reduction in insulin resistance parameters.

Conclusion: Chronic inflammation in PCOS contributes to insulin resistance. Metformin therapy, by improving insulin resistance, reduces hyperinsulinemia and hyperglycemia, leading to decreased production of reactive oxygen species and amelioration of chronic inflammation. This is evidenced by lowered serum fractalkine and hs-CRP levels and improved insulin resistance parameters in this study.