RESEARCH - Combined oral contraceptive use and the risk of SLE

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Arthritis Rheum. 2009 Mar 30;61(4):476-481.

Combined oral contraceptive use and the risk of systemic lupus erythematosus.

Bernier MO, Mikaeloff Y, Hudson M, Suissa S.

McGill Pharmacoepidemiology Research Unit, McGill University,

Montreal, Quebec, Canada.

OBJECTIVE: To assess whether the risk of incident systemic lupus

erythematosus (SLE) is associated with the use of combined oral

contraceptives (COCs), because studies of the link between exogenous

hormonal exposure and the risk of SLE have produced conflicting

results.

METHODS: We conducted a population-based nested case-control study

among women ages 18-45 years, using the UK's General Practice Research

Database. All incident cases of SLE from 1994-2004 (n = 786) were

identified in the database and matched with up to 10 controls (n =

7,817) among women without SLE at the time of the case's diagnosis.

RESULTS: The adjusted rate ratio (RR) of incident SLE associated with

any use of COC was 1.19 (95% confidence interval [95% CI] 0.98-1.45),

whereas with current use it was 1.54 (95% CI 1.15-2.07). The rate was

particularly increased in current users who had only recently started

COC use (RR 2.52, 95% CI 1.14-5.57) compared with longer-term current

users (RR 1.45, 95% CI 1.06-1.99). The risk appeared to be

particularly elevated with current exposure to first- or

second-generation contraceptives (RR 1.65, 95% CI 1.20-2.26), and

increasing with the dose of ethinyl estradiol (RR 1.42, 1.63, and 2.92

for </=30 mug, 31-49 mug, and 50 mug, respectively).

CONCLUSION: The use of COCs is associated with an increased risk of

SLE. This risk is particularly elevated in women who recently started

contraceptive use, suggesting an acute effect in a small subgroup of

susceptible women.

PMID: 19333988

http://www.ncbi.nlm.nih.gov/pubmed/19333988

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