Abstract
Introduction
The effects of drospirenone-containing combined oral contraceptives (COCs) on the risk of venous thromboembolism (VTE) remain controversial due to the challenge in distinguishing between first-time users and restarters, and their different underlying VTE risks, in healthcare databases.
Objectives
The aim of this study was to describe the challenge of studying the risk of VTE among first-time users of drospirenone-containing COCs in a healthcare database and assess the risk among first-time users and restarters.
Methods
We used data from the Clinical Practice Research Datalink to construct two cohorts. The first-time user cohort included all women aged 16–45 years who received a first ever prescription of drospirenone- or levonorgestrel-containing COCs between May 2002 and March 2015. The restarter cohort included those who were restarting a COC after a period of non-use of ≥6 months. Cox proportional hazards models adjusted for high dimensional propensity scores were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
Results
The final cohorts included 55,139 first-time users (3582 drospirenone and 51,557 levonorgestrel) and 162,959 restarters (23,191 drospirenone and 139,768 levonorgestrel). The adjusted HR of VTE associated with drospirenone versus levonorgestrel was 3.19 (95% CI 1.12–9.08) for first-time users and 1.96 (95% CI 1.12–3.41) for restarters.
Conclusions
We found an elevated risk of VTE associated with drospirenone-containing COCs in comparison with levonorgestrel-containing COCs in both cohorts. While left truncation of healthcare databases is a concern for the identification of first-time users, the use of a more explicit cohort of restarters suggests a doubling of VTE risk with drospirenone-containing COCs.
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Funding
Ms Larivée holds a Masters bursary from the Fonds de la recherche en santé du Québec (Quebec Health Research Foundation). Dr Suissa is the recipient of the James McGill Professor award. Dr Filion holds a Canadian Institutes of Health Research (CIHR) New Investigator Award.
Conflicts of interest
Dr. Suissa has consulted for and received speaking fees from Novartis, Boehringer-Ingelheim, and AstraZeneca and research grants from Bayer Pharma AG, Boehringer-Ingelheim, Bristol-Myers Squibb, and Novartis. Ms Larivée, Ms Coulombe, Dr. Tagalakis, and Dr. Filion have no conflicts of interest to report.
Ethical approval
This study was approved by the Independent Scientific Advisory Committee (ISAC) of the CPRD (ISAC protocol 16_009A, which was made available to journal reviewers) and the Research Ethics Board of the Jewish General Hospital in Montreal, Canada.
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Larivée, N., Suissa, S., Coulombe, J. et al. Drospirenone-Containing Oral Contraceptive Pills and the Risk of Venous Thromboembolism: An Assessment of Risk in First-Time Users and Restarters. Drug Saf 40, 583–596 (2017). https://doi.org/10.1007/s40264-017-0525-2
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DOI: https://doi.org/10.1007/s40264-017-0525-2