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Oral Contraceptives OK for Some Patients with Lupus

Two studies show flares, adverse events similar to controls

WEDNESDAY, Dec. 14 (HealthDay News) -- Although the use of oral contraceptives is contraindicated in women with systemic lupus erythematosus (SLE) because of estrogen-related side effects, two studies in the Dec. 15 issue of the New England Journal of Medicine suggest the pill might be considered for patients with inactive or moderately active, stable disease.

Jorge Sanchez-Guerrero, M.D., and colleagues from Mexico City, randomly assigned 162 women with mild and stable SLE to either progestin-only or combined oral contraceptives, or to an intrauterine device (IUD). Global disease activity, flare incidence and latency, and incidence of adverse events were similar in all groups. The SLE disease activity index score was 6.1 for combined contraceptives, 6.4 for progestin-only, and 5.0 for the IUD group; and were not statistically different.

Jill P. Buyon, M.D., of the Hospital for Joint Diseases in New York City, and investigators in the Oral Contraceptives-SELENA trial show similar findings in the second study where 183 women with inactive, or active but stable, SLE were assigned to oral triphasic ethinyl estradiol plus norethindrone. After one year of observation, severe lupus flares occurred in 7.7% women taking oral contraceptives and 7.6% taking placebo. Four or less adverse events occurred in each group.

"Although decisions on the type of contraceptive to use should ultimately be based on patients' preferences and should reflect the patients' values, the option to use combined oral contraceptives in antiphospholipid antibody-negative patients with mild disease appears to be worth consideration in the appropriate clinical setting," according to an editorial.

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