Use of combined hormonal contraceptives among women with systemic lupus erythematosus with and without medical contraindications to oestrogen.
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Author
Mendel, ArielleBernatsky, Sasha
Pineau, Christian A
St-Pierre, Yvan
Hanly, John G
Urowitz, Murray B
Clarke, Ann E
Romero-Diaz, Juanita
Gordon, Caroline
Bae, Sang-Cheol
Wallace, Daniel J
Merrill, Joan T
Buyon, Jill
Isenberg, David A
Rahman, Anisur
Ginzler, Ellen M
Petri, Michelle
Dooley, Mary Anne
Fortin, Paul
Gladman, Dafna D
Steinsson, Kristján
Ramsey-Goldman, Rosalind
Khamashta, Munther A
Aranow, Cynthia
Mackay, Meggan
Alarcón, Graciela
Manzi, Susan
Nived, Ola
Jönsen, Andreas
Zoma, Asad A
van Vollenhoven, Ronald F
Ramos-Casals, Manuel
Ruiz-Irastorza, Giuillermo
Lim, Sam
Kalunian, Kenneth C
Inanc, Murat
Kamen, Diane L
Peschken, Christine A
Jacobsen, Søren
Askanase, Anca
Sanchez-Guerrero, Jorge
Bruce, Ian N
Costedoat-Chalumeau, Nathalie
Vinet, Evelyne
Journal title
Rheumatology (Oxford, England)Publication Volume
58Publication Issue
7Publication Begin page
1259Publication End page
1267
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Show full item recordAbstract
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.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.
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)].
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.
Citation
Mendel A, Bernatsky S, Pineau CA, St-Pierre Y, Hanly JG, Urowitz MB, Clarke AE, Romero-Diaz J, Gordon C, Bae SC, Wallace DJ, Merrill JT, Buyon J, Isenberg DA, Rahman A, Ginzler EM, Petri M, Dooley MA, Fortin P, Gladman DD, Steinsson K, Ramsey-Goldman R, Khamashta MA, Aranow C, Mackay M, Alarcón G, Manzi S, Nived O, Jönsen A, Zoma AA, van Vollenhoven RF, Ramos-Casals M, Ruiz-Irastorza G, Lim S, Kalunian KC, Inanc M, Kamen DL, Peschken CA, Jacobsen S, Askanase A, Sanchez-Guerrero J, Bruce IN, Costedoat-Chalumeau N, Vinet E. Use of combined hormonal contraceptives among women with systemic lupus erythematosus with and without medical contraindications to oestrogen. Rheumatology (Oxford). 2019 Jul 1;58(7):1259-1267. doi: 10.1093/rheumatology/kez014. PMID: 30753683; PMCID: PMC6821299.DOI
10.1093/rheumatology/kez014ae974a485f413a2113503eed53cd6c53
10.1093/rheumatology/kez014
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Except where otherwise noted, this item's license is described as © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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