Disease activity and thromboembolic events in women with systemic lupus erythematosus with and without anti-phospholipid syndrome: users of the 52-mg levonorgestrel-releasing intrauterine system

Purpose The disease status and thromboembolic events in women with systemic lupus erythematosus (SLE), with and without anti-phospholipid syndrome (APS), were evaluated before and after placement of the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS). Methods A retrospective cohort stud...

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Published in:	Archives of gynecology and obstetrics Vol. 299; no. 6; pp. 1597 - 1605
Main Authors:	Rebelo, Rafaella C., Pignaton, Estephania, Valeria Bahamondes, M., Costallat, Lilian T. L., Appenzeller, Simone, Bahamondes, Luis, Fernandes, Arlete
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2019 Springer Nature B.V
Subjects:	Adult Antiphospholipid Syndrome - drug therapy Autoimmune diseases Cohort Studies Endocrinology Female General Gynecology Gynecology Health risk assessment Human Genetics Humans Intrauterine Devices, Medicated - standards Levonorgestrel - pharmacology Levonorgestrel - therapeutic use Lupus Lupus Erythematosus, Systemic - drug therapy Medicine Medicine & Public Health Obstetrics/Perinatology/Midwifery Retrospective Studies Thromboembolism Young Adult Systemic lupus erythematosus Levonorgestrel-releasing intrauterine system Arterial and venous thrombotic events Antiphospholipid syndrome
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Summary:	Purpose The disease status and thromboembolic events in women with systemic lupus erythematosus (SLE), with and without anti-phospholipid syndrome (APS), were evaluated before and after placement of the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS). Methods A retrospective cohort study, with review of medical records of SLE women, who received an LNG-IUS placement between January 2007 and December 2016, carried out at the University of Campinas Medical School, Brazil. The outcomes included the disease activity (SLEDAI-2K) and damage index scores (SLICC/ACR-DI) presented for each year of device use, as well as venous/arterial thrombotic events, insertion up to a median of 5 years. The author’s used χ 2 , Fisher’s exact and the Mann–Whitney tests for analysis and generalized estimating equations for score comparison. Results The study evaluated 46 women with SLE, 18 with and 28 without APS; the mean age (± standard deviation [SD]) was 31.8 (SD ± 8.3) years old. The length of follow-up after LNG-IUS placement was 5.6 (SD ± 2.7) and 4.1 (SD ± 2.3) years for the groups with and without APS, respectively. Comparison of the groups found that the SLEDAI and SLICC mean scores were low for both at baseline, without variations through the follow-up. After LNG-IUS placement, two women presented three thrombotic arterial events, and one of them died from causes unrelated to LNG-IUS use. Conclusions Our results, although restricted, provide information to policymakers and health professionals that the use of a 52 mg LNG-IUS over a 5-year median did not increase disease activity or damage index scores among women with SLE, with and without APS.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0932-0067 1432-0711
DOI:	10.1007/s00404-019-05131-x