Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Estrogen-containing contraceptives may be contraindicated in specific medical conditions due to an increased risk of cardiovascular and thromboembolic events. Women with SLE are at increased risk of having medical contraindications to estrogen use. We assessed the prevalence of estrogen-containing contraceptives in reproductive-aged SLE women with and without possible contraindications.
Methods: Premenopausal women aged 18-45 enrolled in the Systemic Lupus International Collaborating Clinics (SLICC) Registry (2000-2017) were enrolled within 15 months of SLE onset and evaluated yearly to update drug use, including estrogen-containing contraceptives. We assessed the presence of World Health Organization (WHO) category 3 (theoretical or proven risks usually outweighing advantages of use) or category 4 (unacceptable health risk if used) contraindications to estrogen-containing contraceptives. Examples included smoking and age ≥35, hypertension, migraine with aura, positive antiphospholipid antibodies (aPL), and stroke. High disease activity defined as a SLEDAI score >12 or use of >0.5 mg/kg/d of prednisone were also evaluated as relative contraindications since safety of estrogen in this population has not been established.
Results : We identified 1224 SLE women of reproductive age, who contributed 7756 visits. We observed ≥1 possible contraindications to estrogen in 648 (53%) subjects at enrolment and at 4376 (56%) visits over the study period. At baseline, 124 (10%) women were using estrogen-containing contraceptives and among these, 33 (27%) had ≥1 possible contraindication. Across all study visits, estrogen-containing contraceptives were used by 6% (95% CI 5-7) of women with ≥1 possible contraindication vs 12% (95% CI 11-13) of women without any contraindication. Among women using estrogen-containing contraceptives, the most frequently observed WHO category-3 or -4 contraindications were hypertension (44%), positive aPL (32%), and migraine with aura (27%).
Conclusion: In a large international prospective SLE cohort, more than half of SLE women of reproductive age had ≥1 possible contraindication to estrogen-containing contraceptives. Overall use of estrogen-containing contraceptives was low in SLE women (10%) compared to women of reproductive age in the general population (usually above 35%). Estrogen-containing contraceptives were used in 6% of women with possible contraindications. Further work is needed to explore prescribers’ characteristics and prescription patterns over time, and to determine long-term outcomes associated with this exposure.
|
Table 1. Baseline characteristics of reproductive-aged SLE women, overall and among those using estrogen-containing contraceptives with and without 1 or more possible contraindications to estrogen
|
|||
|
Characteristics |
Total population (n=1224) |
Estrogen-containing contraceptive users (n=124) |
|
|
Without contraindication (n=91) |
With 1 or more contraindications (n=33) |
||
|
Age, mean (SD) |
29.8 (7.6) |
26.6 (5.9) |
28.3 (6.6) |
|
Education |
|||
|
Years of education prior to college or university, mean (SD) Years of post-secondary education, mean (SD) Any post-secondary education, n (%) |
11.7 (1.8) 3.6 (2.0) 760 (62) |
11.9 (1.8) 4.0 (2.5) 65 (71) |
11.8 (1.3) 3.3 (1.2) 22 (67) |
|
Ethnicity, n (%) |
|||
|
Asian Native North American Black Caucasian Hispanic Indian subcontinent Other |
209 (17) 5 (0) 22 (18) 486 (40) 212 (17) 39 (3) 48 (4) |
8 (8) 0 (0) 14 (11) 84 (68) 8 (7) 3 (2) 5 (4) |
2 (6) 0 (0) 5 (15) 21 (64) 3 (9) 1 (3) 1 (3) |
|
Country of origin, n (%) |
|||
|
Canada United States Mexico United Kingdom Iceland Spain Sweden Switzerland Denmark Turkey South Korea |
265 (22) 349 (29) 170 (14) 241 (20) 13 (1) 19 (2) 24 (2) 2 (0) 5 (0) 7 (1) 129 (11) |
24 (26) 35 (39) 3 (3) 22 (24) 1 (1) 2 (2) 1 (1) 0 (0) 1 (1) 1 (1) 1 (1) |
11 (33) 12 (36) 3 (9) 3 (9) 2 (6) 0 (0) 2 (6) 0 (0) 0 (0) 0 (0) 0 (0) |
|
Disease duration, years, mean (SD) |
0.46 (0.4) |
0.41 (0.3) |
0.45 (0.4) |
|
BMI, kg/m2, mean (SD) |
24.6 (5.7) |
24.5 (4.2) |
25.2 (5.8) |
|
Table 2. Frequency of contraindications to estrogen use across all study visits among SLE women using estrogen-containing contraceptives with 1 or more possible contraindications |
|
|
Contraindications to estrogen-containing contraceptives |
SLE women using estrogen-containing contraceptives with 1 or more contraindication (n= 255 visits) |
|
Hypertension, n (%)*/** |
114 (45) |
|
Antiphospholipid antibodies, n (%)** |
82 (32) |
|
Migraine with aura, n (%) ** |
69 (27) |
|
History of venous thromboembolism, n (%)*/** |
24 (9) |
|
SLEDAI score >12, n (%)‡ |
21 (8) |
|
Prednisone use ≥0.5 mg/kg/d, n (%)‡ |
19 (7) |
|
Ischemic stroke, n (%)** |
14 (6) |
|
Smoker aged ≥35, n (%)*/** |
10 (4) |
|
Valvular heart disease with pulmonary hypertension, n (%)** |
9 (4) |
|
Ischemic heart disease, n (%)** |
4 (2) |
|
Diabetes ≥ 20 years, n (%)*/** |
3 (1) |
|
History of breast cancer, n (%)** |
1 (0) |
|
Peripheral vascular disease, n (%)** |
1 (0) |
|
*World Health Organization (WHO) Grade 3: theoretical or proven risks usually outweigh the advantages [1] ** WHO Grade 4: unacceptable health risk, method not to be used [1] ‡ Safety in this population has not been established [1] World Health Organization. Medical eligibility criteria for contraceptive use, 5th ed. Geneva: WHO, 2015. |
|
To cite this abstract in AMA style:
Mendel A, Bernatsky S, St.Pierre Y, Pineau C, Vinet E. Use of Estrogen-Containing Contraceptives Among SLE Women with and without Contraindications to Estrogen [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/use-of-estrogen-containing-contraceptives-among-sle-women-with-and-without-contraindications-to-estrogen/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-estrogen-containing-contraceptives-among-sle-women-with-and-without-contraindications-to-estrogen/