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Section Clinical Research

Nimesulide with Metformin Lowers Inflammatory Markers in Women with PCOS

Vol. 10 No. 2 (2025): December:
DOI : https://doi.org/10.21070/acopen.10.2025.12843
Published : Oct 30, 2025

Reyam Mohammed Qasim (1), Maitham Ali Al-Rikabi (2), Edwar Z Khosho (3)

(1) Department of Clinical Pharmacy, Maternity and Children's Hospital, Misan Health Directorate, Misan, Iraq
(2) Department of Clinical Pharmacy, College of Pharmacy, University of Basrah, Iraq
(3) Department of Obstetrics and Gynaecology, College of Medicine, University of Basrah, Iraq
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Abstract:

General Background: Polycystic Ovary Syndrome (PCOS) is a chronic endocrine and metabolic disorder characterized by hyperandrogenism, anovulation, and low-grade systemic inflammation, which contributes to insulin resistance and cardiovascular risk. Specific Background: Metformin, the first-line treatment for PCOS, has known anti-inflammatory properties, but whether its combination with selective COX-2 inhibitors such as nimesulide offers superior anti-inflammatory efficacy remains underexplored. Knowledge Gap: Evidence on adjunctive NSAID therapy targeting inflammation in PCOS is limited, and the combined effects of metformin and nimesulide on key inflammatory biomarkers, interleukin-6 (IL-6) and C-reactive protein (CRP), have not been systematically evaluated. Aims: This study investigated whether adding nimesulide to metformin enhances anti-inflammatory effects in women with PCOS. Results: In a non-randomized controlled study of 100 participants, both treatments significantly reduced IL-6 and CRP; however, combination therapy produced greater CRP reductions (p < 0.001), while IL-6 changes were comparable. Regression analysis identified total cholesterol and free testosterone as independent predictors of residual IL-6 levels (R² = 0.516). Novelty: This study is among the first to demonstrate synergistic anti-inflammatory effects of COX-2 inhibition with metformin in PCOS. Implications: Findings support the integration of metabolic and anti-inflammatory strategies for PCOS management and highlight the need for randomized trials assessing long-term efficacy and safety of adjunctive COX-2 inhibitors.


Highlight:




  • Combination therapy with nimesulide enhances metformin’s anti-inflammatory effect on CRP.




  • IL-6 reduction was comparable between metformin alone and combination treatment.




  • Total cholesterol and free testosterone independently predict residual inflammation.




Keywords: PCOS, Metformin, Nimesulide, Inflammation, C-Reactive Protein

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