title: Efficacy and safety of an ascending-dose, extended-regimen levonorgestrel/ethinyl estradiol combined oral contraceptive.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of an ascending-dose, extended-regimen (ADER) combined oral contraceptive consisting of levonorgestrel (LNG) 150 mcg/ethinyl estradiol (EE) 20 mcg for 42 days, LNG 150 mcg/EE 25 mcg for 21 days, LNG 150 mcg/EE 30 mcg for 21 days and EE 10 mcg for 7 days.
  
  
  METHODS
  This was a multicenter, open-label, phase 3, single-arm study. Sexually active women aged 18-40 years were enrolled and received ADER for up to 1 year (4 consecutive 91-day cycles). Participants kept diaries to record adherence, bleeding/spotting and other contraceptive use. Efficacy was measured using the Pearl Index and the life-table method; safety and tolerability were assessed through reported adverse events (AEs).
  
  
  RESULTS
  A total of 3701 women were enrolled and 2144 completed the study. The Pearl Index was 3.19 [95% confidence interval (CI), 2.49-4.03], based on 70 pregnancies that occurred after ADER initiation and ≤ 7 days after the last LNG/EE or EE-only pill in women aged 18-35 years, excluding cycles in which another contraceptive method was used. Life-table pregnancy rate was 2.82% (95% CI, 2.23%-3.57%) for all users aged 18-35 years. Unscheduled bleeding/spotting decreased with increasing EE doses within each cycle and decreased after cycle 1. No unexpected AEs or changes in laboratory parameters were reported.
  
  
  CONCLUSIONS
  This study demonstrated that ADER effectively prevented pregnancy with a favorable safety and tolerability profile.
authors.affiliation: Columbus Center for Women's Health Research, Columbus, OH, USA. Electronic address: dportman@ccwhr.com.
authors.forename: David J
authors.initials: DJ
authors.lastname: Portman
authors.affiliation: University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Kaunitz
authors.affiliation: Teva Global Medical Affairs, Frazer, PA, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Howard
authors.affiliation: Teva Global Medical Affairs, Petach Tikva, Israel.
authors.forename: Herman
authors.initials: H
authors.lastname: Weiss
authors.affiliation: Teva Branded Pharmaceutical Products, R&D, Inc., West Chester, PA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hsieh
authors.affiliation: Teva Branded Pharmaceutical Products, R&D, Inc., Frazer, PA, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Ricciotti
mesh_terms: D000328:Adult; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects*; D004967:Estrogens / Q000008:administration & dosage* / Q000009:adverse effects; D004997:Ethinyl Estradiol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000009:adverse effects; D008597:Menstrual Cycle / Q000187:drug effects; D011247:Pregnancy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003277:Contraceptives, Oral, Combined; D004967:Estrogens; D004997:Ethinyl Estradiol; D016912:Levonorgestrel
keywords: Bleeding; Contraception; Low dose; Spotting