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

Arielle Mendel; Sasha Bernatsky; Christian A Pineau; Yvan St-Pierre; John G Hanly; Murray B Urowitz; Ann E Clarke; Juanita Romero-Diaz; Caroline Gordon; Sang-Cheol Bae; Daniel J Wallace; Joan T Merrill; Jill Buyon; David A Isenberg; Anisur Rahman; Ellen M Ginzler; Michelle Petri; Mary Anne Dooley; Paul Fortin; Dafna D Gladman; Kristján Steinsson; Rosalind Ramsey-Goldman; Munther A Khamashta; Cynthia Aranow; Meggan Mackay; Graciela Alarcón; Susan Manzi; Ola Nived; Andreas Jönsen; Asad A Zoma; Ronald F van Vollenhoven; Manuel Ramos-Casals; Giuillermo Ruiz-Irastorza; Sam Lim; Kenneth C Kalunian; Murat Inanc; Diane L Kamen; Christine A Peschken; Søren Jacobsen; Anca Askanase; Jorge Sanchez-Guerrero; Ian N Bruce; Nathalie Costedoat-Chalumeau; Evelyne Vinet

doi:10.1093/rheumatology/kez014

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

Arielle Mendel, Sasha Bernatsky, Christian A Pineau, Yvan St-Pierre, John G Hanly, Murray B Urowitz, Ann E Clarke, Juanita Romero-Diaz, Caroline Gordon, Sang-Cheol Bae, Daniel J Wallace, Joan T Merrill, Jill Buyon, David A Isenberg, Anisur Rahman, Ellen M Ginzler, Michelle Petri, Mary Anne Dooley, Paul Fortin, Dafna D GladmanKristján Steinsson, Rosalind Ramsey-Goldman, Munther A Khamashta, Cynthia Aranow, Meggan Mackay, Graciela Alarcón, Susan Manzi, Ola Nived, Andreas Jönsen, Asad A Zoma, Ronald F van Vollenhoven, Manuel Ramos-Casals, Giuillermo Ruiz-Irastorza, Sam Lim, Kenneth C Kalunian, Murat Inanc, Diane L Kamen, Christine A Peschken, Søren Jacobsen, Anca Askanase, Jorge Sanchez-Guerrero, Ian N Bruce, Nathalie Costedoat-Chalumeau, Evelyne Vinet

Department for Rheumatology and Spine Diseases

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 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.

Original language	English
Journal	Rheumatology (Oxford, England)
Volume	58
Issue number	7
Pages (from-to)	1259-1267
Number of pages	9
ISSN	1462-0324
DOIs	https://doi.org/10.1093/rheumatology/kez014
Publication status	Published - 1 Jul 2019

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Mendel, A., Bernatsky, S., Pineau, C. A., St-Pierre, Y., Hanly, J. G., Urowitz, M. B., Clarke, A. E., Romero-Diaz, J., Gordon, C., Bae, S.-C., Wallace, D. J., Merrill, J. T., Buyon, J., Isenberg, D. A., Rahman, A., Ginzler, E. M., Petri, M., Dooley, M. A., Fortin, P., ... Vinet, E. (2019). Use of combined hormonal contraceptives among women with systemic lupus erythematosus with and without medical contraindications to oestrogen. Rheumatology (Oxford, England), 58(7), 1259-1267. https://doi.org/10.1093/rheumatology/kez014

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 et al.
In: Rheumatology (Oxford, England), Vol. 58, No. 7, 01.07.2019, p. 1259-1267.

Research output: Contribution to journal › Journal article › Research › peer-review

Mendel, A, Bernatsky, S, Pineau, CA, St-Pierre, Y, Hanly, JG, Urowitz, MB, Clarke, AE, Romero-Diaz, J, Gordon, C, Bae, S-C, 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 2019, 'Use of combined hormonal contraceptives among women with systemic lupus erythematosus with and without medical contraindications to oestrogen', Rheumatology (Oxford, England), vol. 58, no. 7, pp. 1259-1267. https://doi.org/10.1093/rheumatology/kez014

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

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 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.",

author = "Arielle Mendel and Sasha Bernatsky and Pineau, {Christian A} and Yvan St-Pierre and Hanly, {John G} and Urowitz, {Murray B} and Clarke, {Ann E} and Juanita Romero-Diaz and Caroline Gordon and Sang-Cheol Bae and Wallace, {Daniel J} and Merrill, {Joan T} and Jill Buyon and Isenberg, {David A} and Anisur Rahman and Ginzler, {Ellen M} and Michelle Petri and Dooley, {Mary Anne} and Paul Fortin and Gladman, {Dafna D} and Kristj{\'a}n Steinsson and Rosalind Ramsey-Goldman and Khamashta, {Munther A} and Cynthia Aranow and Meggan Mackay and Graciela Alarc{\'o}n and Susan Manzi and Ola Nived and Andreas J{\"o}nsen and Zoma, {Asad A} and {van Vollenhoven}, {Ronald F} and Manuel Ramos-Casals and Giuillermo Ruiz-Irastorza and Sam Lim and Kalunian, {Kenneth C} and Murat Inanc and Kamen, {Diane L} and Peschken, {Christine A} and S{\o}ren Jacobsen and Anca Askanase and Jorge Sanchez-Guerrero and Bruce, {Ian N} and Nathalie Costedoat-Chalumeau and Evelyne Vinet",

note = "{\textcopyright} The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected].",

year = "2019",

month = jul,

day = "1",

doi = "10.1093/rheumatology/kez014",

language = "English",

volume = "58",

pages = "1259--1267",

journal = "Rheumatology (Oxford, England)",

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publisher = "Oxford University Press",

number = "7",

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TY - JOUR

T1 - Use of combined hormonal contraceptives among women with systemic lupus erythematosus with and without medical contraindications to oestrogen

AU - Mendel, Arielle

AU - Bernatsky, Sasha

AU - Pineau, Christian A

AU - St-Pierre, Yvan

AU - Hanly, John G

AU - Urowitz, Murray B

AU - Clarke, Ann E

AU - Romero-Diaz, Juanita

AU - Gordon, Caroline

AU - Bae, Sang-Cheol

AU - Wallace, Daniel J

AU - Merrill, Joan T

AU - Buyon, Jill

AU - Isenberg, David A

AU - Rahman, Anisur

AU - Ginzler, Ellen M

AU - Petri, Michelle

AU - Dooley, Mary Anne

AU - Fortin, Paul

AU - Gladman, Dafna D

AU - Steinsson, Kristján

AU - Ramsey-Goldman, Rosalind

AU - Khamashta, Munther A

AU - Aranow, Cynthia

AU - Mackay, Meggan

AU - Alarcón, Graciela

AU - Manzi, Susan

AU - Nived, Ola

AU - Jönsen, Andreas

AU - Zoma, Asad A

AU - van Vollenhoven, Ronald F

AU - Ramos-Casals, Manuel

AU - Ruiz-Irastorza, Giuillermo

AU - Lim, Sam

AU - Kalunian, Kenneth C

AU - Inanc, Murat

AU - Kamen, Diane L

AU - Peschken, Christine A

AU - Jacobsen, Søren

AU - Askanase, Anca

AU - Sanchez-Guerrero, Jorge

AU - Bruce, Ian N

AU - Costedoat-Chalumeau, Nathalie

AU - Vinet, Evelyne

PY - 2019/7/1

Y1 - 2019/7/1

N2 - 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.

AB - 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.

U2 - 10.1093/rheumatology/kez014

DO - 10.1093/rheumatology/kez014

M3 - Journal article

C2 - 30753683

SN - 1462-0324

VL - 58

SP - 1259

EP - 1267

JO - Rheumatology (Oxford, England)

JF - Rheumatology (Oxford, England)

IS - 7

ER -

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

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