title: Polycystic ovary syndrome and combined oral contraceptive use: a comparison of clinical practice in the United States to treatment guidelines.
abstract: The October 2010 ESHRE/ASRM polycystic ovary syndrome (PCOS) workshop concluded: (1) all combined oral contraceptives (COC) appear to have equal efficacy for PCOS, (2) addition of antiandrogens (spironolactone) to COCs has little treatment benefit and (3) metformin does not improve the live-birth rate and should only be used with impaired glucose tolerance. We compared these guidelines to current practice in the United States IMS claims-database. Time-series analyses were conducted by calendar-year in women with PCOS to evaluate prescribing preferences for COCs, concomitant use of spironolactone, and utilization of metformin. Trends were analyzed with linear regression. Our cohort included 1.6 million women taking COCs, 46 780 with a PCOS claim. Drospirenone utilization increased by 1.52% (SE:0.48%, p = 0.007) per-year more in women with PCOS (4.16%, SE:0.45%, p < 0.001) than in women without PCOS (2.64%, SE:0.17%, p < 0.001)). Concomitant use of drospirenone and spironolactone was common (14.26%) and increased by 0.75% (SE:0.15%, p = 0.002) per-year. Although plasma glucose tests were unavailable, women with PCOS were more likely to take metformin than have a diabetes claim (45.8% versus 15.2%, p < 0.001), indicating some women likely receive metformin solely for PCOS. Our data suggests further attention is needed to medication management of PCOS to bridge the gap between guidelines and practice.
authors: College of Pharmacy and Epidemiology, Pharmaceutical Outcomes & Policy, University of Florida, Newell Drive (HPNP), Gainesville, FL, USA. bird.steven@gmail.com
authors: Steven T
authors: ST
authors: Bird
authors: Abraham G
authors: AG
authors: Hartzema
authors: Mahyar
authors: M
authors: Etminan
authors: James M
authors: JM
authors: Brophy
authors: Joseph A C
authors: JA
authors: Delaney
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use*; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use*; D016208:Databases, Factual; D011307:Drug Prescriptions; D005260:Female; D018149:Glucose Intolerance / Q000150:complications / Q000188:drug therapy; D019983:Guideline Adherence; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008687:Metformin / Q000627:therapeutic use*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D013148:Spironolactone / Q000627:therapeutic use*; D014481:United States
chemical_list: D000726:Androgen Antagonists; D003277:Contraceptives, Oral, Combined; D007004:Hypoglycemic Agents; D013148:Spironolactone; D008687:Metformin