Oral contraceptives may not worsen SLE symptoms

Two recent studies support the safe use of combined oral contraceptives (OCs) in systemic lupus erythematosus (SLE) patients with inactive or moderately active, stable disease.In the first paper Dr Jorge Sánchez-Guerrero and colleagues comment that the effects of estrogen-containing contraceptives on disease activity in women with systemic lupus erythematosus "have not been determined" and overall, the data suggests, "estrogens favour the development or exacerbation of the disease."Dr Sánchez-Guerrero's team randomised 162 women with SLE to use combined OCs, a progestin-only pill, or a copper intrauterine device (IUD). At baseline, each group had similar demographic features and disease characteristics, with mean SLEDAI score of 6.1 (± 5.6) in the combined OC group, 6.4 (± 4.6) in the progestin-only group, and 5.0 (± 5.3) in the IUD group (p=0.36).The authors report that throughout the 12-month trial, disease activity remained mild and stable in all groups. There were no significant differences among the groups during the trial in global or maximum disease activity, incidence or probability of flares, or medication use. The median time to the first flare was three months in each group.Overall, thromboses occurred in four patients (two in each of the two groups receiving hormones), and severe infections were more frequent in the IUD group. One patient receiving combined oral contraceptives died from amoxicillin-related severe neutropenia."Our results do not support concerns that the use of exogenous estrogens by women with systemic lupus erythematosus will lead to disease exacerbation," the investigators conclude. "Although estrogen-containing oral-contraceptive regimens do not appear to increase the risk of disease exacerbation in women with systemic lupus erythematosus, one should still be cautious about the possibility of an increased risk of thrombosis with hormonal methods of contraception," they add.In the second paper Dr Michelle Petri's group conducted a randomised, double-blind, placebo-controlled, multicenter study of combined OCs in 183 women with inactive (76%) or stable active (24%) SLE. Subjects were excluded if they had moderate or high levels of anticardiolipin antibodies, lupus anticoagulant, or a history of thrombosis.The primary end-point of severe lupus flare occurred in 7 (7.7%) of 91 women receiving OCs and in 7 (7.6%) of 92 women receiving placebo. Twelve-month rates of severe flare were 0.084 in the OC group and 0.087 in the placebo group (p=0.95). Rates of mild or moderate flares were 1.40 flares per person-year in the OC group and 1.44 flares per person-year in the placebo group (p=0.86).The authors comment, "Our study indicates that oral contraceptives do not increase the risk of flare among women with systemic lupus erythematosus whose disease is stable. These data support the use of oral contraceptives containing estrogen as a birth-control choice for patients with inactive or stable, moderate systemic lupus erythematosus who are at low risk for thrombosis."Reference...