Oral contraceptives do not appear to affect cystic fibrosis disease severity

Abstract

Several studies suggest that sex may affect cystic fibrosis (CF) disease severity, with females with CF being more severely affected. In this context, it has been suggested that sex hormones may influence the CF phenotype. A large proportion of females with CF regularly use oral contraceptives (OCs), but the effect of their use on disease severity is unclear. Here, we retrospectively assessed the effects of OCs on clinical outcomes in females with CF.Data from 681 females were available, of whom 42% had taken OCs for varying periods of time. We first performed an inter-patient analysis comparing annual change in % predicted forced expiratory volume in 1 s, body mass index and total days of intravenous antibiotic use over a 5-yr study period in 57 females exposed to and 57 females not exposed to OCs. There were no differences between the two groups. We next performed an intra-patient analysis of the same outcomes over a 3-yr period of OC exposure and a 3-yr period of no OC exposure in the same patient (exposure followed by non-exposure, n527; non-exposure followed by exposure, n523), but again did not detect any differences in any of the clinical outcomes.Our data suggests that the use of OCs does not affect CF disease severity.

Contraceptive safety among women with cystic fibrosis: a systematic review

“…After reviewing the titles and abstracts of these articles, as well as the full articles when necessary, six articles met our inclusion criteria [8][9][10][11][12][13] and an additional article was identified examining contraceptive use among women, most with CF, after undergoing lung transplantation [14] (Table 1). Of the seven included articles, four examined measures of disease severity or other CF-related health outcomes and four, including one that also examined disease severity, examined measures of effectiveness (three reported on pregnancies and one was a pharmacokinetic study).…”

“…Evidence from three observational studies, including two cohort studies [8,9] and one follow-up study without a comparison group [10], suggest that OC use among women with CF does not negatively impact their disease severity, as measured by changes in pulmonary function and exacerbation rate compared to women with CF not taking OCs [8,9] or changes in pulmonary function and exacerbations compared to values before starting COCs [10]. One of the studies also included a repeated cross-sectional analysis and an intrapatient comparison, both of which suggest a potential protective effect of OCs against CF exacerbations [9].…”

“…One of these studies specified that the method examined was combined oral contraceptives (COCs) [10], whereas two did not specify the type of OC [8,9]. One study was a retrospective cohort study [8], one included a prospective cohort analysis, a repeated cross-sectional analysis, and an intrapatient analysis [9], and one was a follow-up study without a comparison group [10]. Finally, a small follow-up study without a comparison group reported in a letter to the editor examined women with CF who initiated depot-medroxyprogesterone acetate (DMPA) and reported diabetes-related outcomes [13].…”

“…Three studies examined measures of disease severity, such as pulmonary function [e.g., forced expiratory volume in 1 s as a percentage of predicted (FEV 1 % pred)] or measures of clinical disease manifestation (e.g., infective exacerbations, intravenous antibiotic use) among women using OCs [8][9][10]. One of these studies specified that the method examined was combined oral contraceptives (COCs) [10], whereas two did not specify the type of OC [8,9].…”

“…A retrospective cohort study examined data from an annual review of CF female patients aged 16-45 years at a single institution, including 55 women who used OCs (type not specified) for at least 4 out of 5 continuous years and 55 women who never used OCs, matched by age and year of birth [8]. During the 5-year study period, there were no statistically significant differences between those exposed and those not exposed to OCs in median annual change in FEV 1 % pred (− 1.87% vs. − 1.03%, p =.1), average total days on intravenous antibiotics (49 days vs. 42 days, p =.7) or median annual change in BMI (0.05 vs. − 0.07, p =.9).…”