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Use of combined hormonal contraceptives among women with systemic lupus erythematosus with and without medical contraindications to oestrogen

Mendel, Arielle; Bernatsky, Sasha; Pineau, Christian A.; St-Pierre, Yvan; Hanly, John G.; Urowitz, Murray B.; Clarke, Ann E.; Romero-Diaz, Juanita; Gordon, Caroline and Bae, Sang Cheol, et al. (2019) In Rheumatology (United Kingdom) 58(7). p.1259-1267
Abstract

Objectives. To assess the prevalence of combined hormonal contraceptives (CHCs) in reproductive-age women with SLE with and without possible contraindications and to determine factors associated with their use in the presence of possible contraindications. Methods. This observational cohort study included premenopausal women ages 18-45 years enrolled in the SLICC Registry ≤15 months after SLE onset, with annual assessments spanning 2000-2017. World Health Organization Category 3 or 4 contraindications to CHCs (e.g. hypertension, aPL) were assessed at each study visit. High disease activity (SLEDAI score >12 or use of >0.5 mg/kg/day of prednisone) was considered a relative contraindication. Results. A total of 927 SLE women... (More)

Objectives. To assess the prevalence of combined hormonal contraceptives (CHCs) in reproductive-age women with SLE with and without possible contraindications and to determine factors associated with their use in the presence of possible contraindications. Methods. This observational cohort study included premenopausal women ages 18-45 years enrolled in the SLICC Registry ≤15 months after SLE onset, with annual assessments spanning 2000-2017. World Health Organization Category 3 or 4 contraindications to CHCs (e.g. hypertension, aPL) were assessed at each study visit. High disease activity (SLEDAI score >12 or use of >0.5 mg/kg/day of prednisone) was considered a relative contraindication. Results. A total of 927 SLE women contributed 6315 visits, of which 3811 (60%) occurred in the presence of one or more possible contraindication to CHCs. Women used CHCs during 512 (8%) visits, of which 281 (55%) took place in the setting of one or more possible contraindication. The most frequently observed contraindications were aPL (52%), hypertension (34%) and migraine with aura (22%). Women with one or more contraindication were slightly less likely to be taking CHCs [7% of visits (95% CI 7, 8)] than women with no contraindications [9% (95% CI 8, 10)]. Conclusion. CHC use was low compared with general population estimates (>35%) and more than half of CHC users had at least one possible contraindication. Many yet unmeasured factors, including patient preferences, may have contributed to these observations. Further work should also aim to clarify outcomes associated with this exposure.

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type
Contribution to journal
publication status
published
subject
keywords
Anti-phospholipid syndrome, Contraception, Epidemiology, Systemic lupus erythematosus
in
Rheumatology (United Kingdom)
volume
58
issue
7
pages
9 pages
publisher
Oxford University Press
external identifiers
  • scopus:85068445914
ISSN
1462-0324
DOI
10.1093/rheumatology/kez014
language
English
LU publication?
yes
id
fc4cf98c-a54e-419c-a74b-ea4a9a2c2f5b
date added to LUP
2019-07-22 10:51:16
date last changed
2019-08-06 03:25:04
@article{fc4cf98c-a54e-419c-a74b-ea4a9a2c2f5b,
  abstract     = {<p>Objectives. To assess the prevalence of combined hormonal contraceptives (CHCs) in reproductive-age women with SLE with and without possible contraindications and to determine factors associated with their use in the presence of possible contraindications. Methods. This observational cohort study included premenopausal women ages 18-45 years enrolled in the SLICC Registry ≤15 months after SLE onset, with annual assessments spanning 2000-2017. World Health Organization Category 3 or 4 contraindications to CHCs (e.g. hypertension, aPL) were assessed at each study visit. High disease activity (SLEDAI score &gt;12 or use of &gt;0.5 mg/kg/day of prednisone) was considered a relative contraindication. Results. A total of 927 SLE women contributed 6315 visits, of which 3811 (60%) occurred in the presence of one or more possible contraindication to CHCs. Women used CHCs during 512 (8%) visits, of which 281 (55%) took place in the setting of one or more possible contraindication. The most frequently observed contraindications were aPL (52%), hypertension (34%) and migraine with aura (22%). Women with one or more contraindication were slightly less likely to be taking CHCs [7% of visits (95% CI 7, 8)] than women with no contraindications [9% (95% CI 8, 10)]. Conclusion. CHC use was low compared with general population estimates (&gt;35%) and more than half of CHC users had at least one possible contraindication. Many yet unmeasured factors, including patient preferences, may have contributed to these observations. Further work should also aim to clarify outcomes associated with this exposure.</p>},
  author       = {Mendel, Arielle and Bernatsky, Sasha and Pineau, Christian A. and St-Pierre, Yvan and Hanly, John G. and Urowitz, Murray B. and Clarke, Ann E. and Romero-Diaz, Juanita and Gordon, Caroline and Bae, Sang Cheol and Wallace, Daniel J. and Merrill, Joan T. and Buyon, Jill and Isenberg, David A. and Rahman, Anisur and Ginzler, Ellen M. and Petri, Michelle and Dooley, Mary Anne and Fortin, Paul and Gladman, Dafna D. and Steinsson, Kristján and Ramsey-Goldman, Rosalind and Khamashta, Munther A. and Aranow, Cynthia and MacKay, Meggan and Alarcón, Graciela and Manzi, Susan and Nived, Ola and Jönsen, Andreas and Zoma, Asad A. and Van Vollenhoven, Ronald F. and Ramos-Casals, Manuel and Ruiz-Irastorza, Giuillermo and Lim, Sam and Kalunian, Kenneth C. and Inanc, Murat and Kamen, Diane L. and Peschken, Christine A. and Jacobsen, Søren and Askanase, Anca and Sanchez-Guerrero, Jorge and Bruce, Ian N. and Costedoat-Chalumeau, Nathalie and Vinet, Evelyne},
  issn         = {1462-0324},
  keyword      = {Anti-phospholipid syndrome,Contraception,Epidemiology,Systemic lupus erythematosus},
  language     = {eng},
  number       = {7},
  pages        = {1259--1267},
  publisher    = {Oxford University Press},
  series       = {Rheumatology (United Kingdom)},
  title        = {Use of combined hormonal contraceptives among women with systemic lupus erythematosus with and without medical contraindications to oestrogen},
  url          = {http://dx.doi.org/10.1093/rheumatology/kez014},
  volume       = {58},
  year         = {2019},
}