title: Pregnane progestin contraception in systemic lupus erythematosus: a longitudinal study of 187 patients.
abstract: BACKGROUND
  Systemic lupus erythematosus (SLE) affects women of child-bearing age. Combined oral contraceptives can worsen the course and increase the risk of thrombosis. The objectives of this study were to provide an alternative contraception and thus evaluate the gynecological tolerability of pregnane progestins (PPs) in SLE patients. Systemic lupus erythematosus disease activity and vascular tolerance were also reported.
  
  
  METHODS
  We used two PP with antigonadotropic potencies, chlormadinone acetate (CMA, 10 mg/day) and cyproterone acetate (CPA, 50 mg/day), administered orally for contraception in 187 SLE patients observed for 46±34.6 months (mean±S.E.), i.e., 6854 women-months.
  
  
  RESULTS
  The gynecological tolerability was satisfactory: breakthrough bleeding was reported in 17.7% patients using CPA and 12.6% patients using CMA. No pregnancy was observed in the women followed in this cohort study. One deep vein thrombosis, one myocardial infarction, and one tibial posterior arterial occlusion were observed, giving an incidence for venous thromboembolism of 1.39/year×1000 women (95% CI 0-4.12) and for macroarterial disease an incidence of 2.79/year×1000 women (95% CI 0-6.65). Disease activity was less than before progestins.
  
  
  CONCLUSIONS
  Pregnane progestin contraception is effective and well tolerated, thus providing SLE patients an excellent contraceptive alternative to the currently used methods.
authors.affiliation: Université Paris Descartes, APHP Unité de Gynécologie Endocrinienne, Hôtel Dieu de Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Chabbert-Buffet
authors.forename: Zahir
authors.initials: Z
authors.lastname: Amoura
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Scarabin
authors.forename: Camille
authors.initials: C
authors.lastname: Frances
authors.forename: Delphine P
authors.initials: DP
authors.lastname: Lévy
authors.forename: Lionel
authors.initials: L
authors.lastname: Galicier
authors.forename: Bertrand
authors.initials: B
authors.lastname: Wechsler
authors.forename: Olivier
authors.initials: O
authors.lastname: Blétry
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Piette
authors.forename: Anne
authors.initials: A
authors.lastname: Gompel
mesh_terms: D000293:Adolescent; D000328:Adult; D000726:Androgen Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D017152:Antibodies, Antiphospholipid / Q000097:blood; D016009:Chi-Square Distribution; D002715:Chlormadinone Acetate / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D003267:Contraception / Q000379:methods*; D017373:Cyproterone Acetate / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000276:immunology / Q000503:physiopathology*; D008875:Middle Aged; D011446:Prospective Studies; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000726:Androgen Antagonists; D017152:Antibodies, Antiphospholipid; D002715:Chlormadinone Acetate; D017373:Cyproterone Acetate