P-869: Combination suppressive therapy in the polycystic ovary syndrome (PCOS): Predictors of success

Abstract

To determine the independent variables that may be used to predict success in treating PCOS patients with combination oral contraceptives and spironolactone (OCP+SPA), and to assess whether these predictors also influence the length of treatment necessary for a successful outcome. Retrospective chart review. The charts of 172 patients with PCOS treated with OCP+SPA were reviewed and data abstracted using a uniform form. Data included the time of initial consult; the initial modified Ferriman-Gallwey (mFG) score; the levels of total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), and DHEAS; age, race, and body mass index (BMI). These patients were then followed over time and re-evaluated at various intervals for improvement, stabilization, or worsening of hirsutism; 138 patients returned for follow-up and were included in the final analysis. Kaplan-Meier analysis was utilized to determine the percent of patients improved over time. The Cox Hazard regression model was used to assess potential simultaneous influences on hirsutism improvement rates. Independent variables were assessed with both bivariate and multivariate analysis. 1. The median time to follow up was 23 months (range:1.9-153.7 months). Approximately 93% of the 243 subjects were White, the median age was 25 yrs. (range: 13-47 yrs.), the median BMI 31.0 kg/m2 (range: 17.8-65.0 kg/m2), and the median initial mFG score was 9.0 (range: 0-27). 2. Approximately 50% of patients self-reported improvement by 25 months of treatment (Figure 1). 3. Age, race, BMI, log TT, log FT and log DHEAS were not found to be independent predictors of successful treatment. 4. Using bivariate analysis, the improvement rate decreased as the initial mFG score and the log SHBG increased. 5. Using multivariate analysis, the initial mFG score and the log SHBG were the only significant predictors of successful treatment. A model predicting success was constructed, which posits that, controlling for mFG score, for every 1-unit increase in log SHBG, the average rate of hirsutism improvement per 100 person-months decreased by a factor of 0.547. Controlling for log SHBG, for every 10-point increase in initial FG score, the average rate of hirsutism improvement per 100 person-months decreased by a factor of 0.741. 1. Successful treatment of hirsutism with combination OCP+SPA therapy requires a minimum of 6 to 12 months of treatment, and the proportion of successfully treated patients continues to increase over subsequent years. 2. The probability of any given patient experiencing improvement an improvement in hirsutism at a any given point in time is higher with a lower initial mFG score and SHBG level.