Systemic Lupus Erythematosus

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Combined oral contraceptive use and the risk of systemic lupus erythematosus

  1. Marie-odile Bernier1,*,
  2. Yann Mikaeloff2,4,
  3. Marie Hudson3,
  4. Samy SuissA3,†

Article first published online: 30 MAR 2009

DOI: 10.1002/art.24398

Issue

Arthritis Care & Research

Arthritis Care & Research

Volume 61, Issue 4, pages 476–481, 15 April 2009

Additional Information

How to Cite

Bernier, M.-o., Mikaeloff, Y., Hudson, M. and SuissA, S. (2009), Combined oral contraceptive use and the risk of systemic lupus erythematosus. Arthritis Care & Research, 61: 476–481. doi: 10.1002/art.24398

Author Information

  1. 1

    McGill Pharmacoepidemiology Research Unit, McGill University, Montreal, Quebec, Canada

  2. 2

    McGill Pharmacoepidemiology Research Unit, McGill University, Montreal, Quebec, Canada

  3. 3

    McGill Pharmacoepidemiology Research Unit, McGill University, and SMBD Jewish General Hospital, Montreal, Quebec, Canada

  4. 4

    INSERM U822 and Assistance Publique Hôpitaux de Paris, Bicêtre University Hospital, Le Kremlin Bicêtre, France

  1. †

    Dr. Suissa has received consultancies and funding for other projects from Organon and Schering.

*Centre for Clinical Epidemiology, SMBD Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, Québec, Canada H3T 1E2

Publication History

  1. Issue published online: 30 MAR 2009
  2. Article first published online: 30 MAR 2009
  3. Manuscript Accepted: 5 JAN 2009
  4. Manuscript Received: 24 JUL 2008

Funded by

  • Canadian Institutes of Health Research
  • Canadian Foundation for Innovation
  • Distinguished Investigator Award from the Canadian Institutes of Health Research

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Abstract

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 μg, 31–49 μg, and 50 μg, 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.

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