Preliminary report of patients with meningiomas exposed to Cyproterone Acetate, Nomegestrol Acetate and Chlormadinone Acetate – Monocentric ongoing study on progestin related meningiomas

Devalckeneer, Antoine; Aboukaïs, Rabih; Bourgeois, Philippe; Witte, Olivier De; Racapé, Judith; Caron, S.; Perbet, Romain; Maurage, Claude‐Alain; Lejeune, Jean‐Paul

doi:10.1016/j.clineuro.2021.106959

Cited by 7 publications

(15 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…By contrast, a high risk of meningioma has been observed with the use of high doses of cyproterone acetate (CPA), a potent progestogen with antiandrogen activity, among women, men and transwomen [11][12][13]. Furthermore, the withdrawal of long-term CPA treatment induces tumour regression, which has also been observed after the withdrawal of two other potent progestogens-nomegestrol acetate (NOMAC) and chlormadinone acetate (CMA) [14][15][16][17][18][19][20][21][22][23]-suggesting that these two progestogens are also associated with the risk of meningioma. However, unlike CPA, no large epidemiological studies have yet been published on the risk of meningioma associated with exposure to NOMAC or CMA.…”

mentioning

confidence: 99%

Risk of intracranial meningioma with three potent progestogens: A population‐based case–control study

Hoisnard

Laanani

Passeri

et al. 2022

Euro J of Neurology

View full text Add to dashboard Cite

Background and purpose A dose‐dependent association between the use of cyproterone acetate (CPA) and intracranial meningioma has been identified but data for other potent progestogens are scarce. The association was assessed between intracranial meningioma surgery and exposure to three potent progestogens: CPA (≥25 mg/day), nomegestrol acetate (NOMAC) (3.75–5 mg/day) and chlormadinone acetate (CMA) (2–10 mg/day). Methods In this nationwide population‐based case–control study, cases underwent surgery for intracranial meningioma in France from 2009 to 2018. They were matched to five control subjects for sex, year of birth and area of residence. Progestogen exposure was defined as progestogen use within the year before surgery for cases or the same date for their controls. Results In total, 25,216 cases were included (75% women, median age 58 years). Progestogen exposure was noted for 9.9% of cases (2497/25,216) and 1.9% (2382/126,080) of controls, with an odds ratio (OR) of 6.7 (95% confidence interval [CI] 6.3–7.1). The OR was 1.2 (1.0–1.4) for short‐term use (<1 year) and 9.5 (8.8–10.2) for prolonged use. A strong association was identified for prolonged use of CPA (OR = 22.7, 95% CI 19.5–26.4), NOMAC (OR = 6.5, 95% CI 5.8–7.2) and CMA (OR = 4.7, 95% CI 4.5–5.3). Progestogen exposure increased the risk of meningioma for all histological grades and anatomical sites, particularly for the anterior and middle skull base: OR = 35.7 (95% CI 26.5–48.2) and 23.9 (95% CI 17.8–32.2) for CPA. The estimated number of attributable cases was 2124 (95% CI 2028–2220) (212/year). Conclusion A strong association between prolonged exposure to potent progestogens and surgery for meningioma was observed. The risk increased from CMA to NOMAC to CPA. Individuals should be informed of this risk.

show abstract

mentioning

confidence: 99%

Risk of intracranial meningioma with three potent progestogens: A population‐based case–control study

Hoisnard

Laanani

Passeri

et al. 2022

Euro J of Neurology

View full text Add to dashboard Cite

show abstract

“…This is in line with three similar recently published studies. 14,18,22 Malaize et al 22 carried out a retrospective clinical and radiological follow-up of 71 progestogeninduced meningiomas with surgical or conservative management. Graillon et al 18 studied the radiological follow-up of 53 patients with CPA, CMA, or NMA meningiomas, with a mean follow-up of 3 years.…”

Section: Discussionmentioning

confidence: 99%

“…confirmed the hypothesis of increased risk, especially in patients treated with high-dose CPA. 4,[13][14][15][16] As early suggested in a case report in 2010, 7 a cohort study demonstrated a noticeable reduction in risk after CPA discontinuation. 16 Today, prolonged progestogen exposure, skull base location, the absence of spinal location, progestogen receptors, and a mutational landscape with a high PI3K mutation rate and a low NF2 mutation rate are currently considered as solid arguments for progestogens tumorigenesis.…”

mentioning

confidence: 82%

“…11 Recently, literature reports and pharmacovigilance surveys pointed out the risk of meningiomas with other progestogens such as nomegestrol acetate (NMA) and chlormadinone acetate (CMA). 11,14,17,18 Therefore, the summary of product characteristics of these progestogens now includes a formal contraindication in patients developing meningioma or having a history of meningioma, and MRI surveillance of patients with long-duration CPA, NMA, or CMA exposure is recommended and should allow earlier meningioma diagnosis. 19,20 Management of progestogen-induced meningioma starts with progestogen discontinuation 8,10,21 and is either conservative with simple clinical and MRI radiological follow-up or interventional with surgery and/or radiotherapy for aggressive presentations.…”

mentioning

confidence: 99%

“…In situations of corticosteroids sensitive symptoms, strategy is however discussed on a case-by-case basis with patients. Outcome and management of progestogen-related meningioma have been studied 14,18,22 ; however, assessments with volumetric data are still very few.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Radiological evolution of progestogen‐induced meningioma: A monocentric retrospective study

Ahmed-Khalifa¹,

Gillet²,

Blonski

et al. 2023

Fundamemntal Clinical Pharma

View full text Add to dashboard Cite

Cyproterone acetate (CPA) is known to induce meningioma, and recently, nomegestrol acetate (NMA) and chlormadinone acetate (CMA) were also involved. Progestagen‐induced meningioma management starts with progestogen discontinuation and is either interventional (surgery and/or radiotherapy) or conservative (clinical and MRI radiological follow‐up). We performed a retrospective volumetric radiological outcomSe study of progestogen‐induced meningiomas diagnosed in our hospital. We analysed progestogen‐related meningiomas diagnosed until 30 June 2021, with at least one diagnostic and one follow‐up MRI results. Meningioma volumes were centrally retrospectively measured using a T1‐weighted 3D millimeter sequence with gadolinium injection on a postprocessing console. We analysed 98 meningiomas of 38 females and one transgender (male‐to‐female), of which 25 (64.1%) had taken CPA, seven (17.9%) NMA, three (7.7%) CMA, and four (10.2%) several progestogens. Eleven patients (24 meningiomas) underwent interventional management, seven patients had meningiomas followed by conservative or interventional management, and 21 patients (51 meningiomas) had only conservative management. Of these 21 patients, 17 had discontinued their progestogen less than 6 months before, of which 14 (82.3%) had decreased or stable meningioma(s) during a 24‐month median follow‐up (3 to 75) period. Overall, four of the 39 patients experienced meningioma progression (three during conservative treatment and one after surgery), including two patients who had continued NMA or CMA treatment several years after diagnosis. Our study confirms a generally favourable outcome of progestogen‐related meningioma after conservative treatment, especially for CPA. It also underlines the need for progestogen discontinuation at meningioma diagnosis.

show abstract

Chlormadinone/nomegestrol

2022

Reactions Weekly

View full text Add to dashboard Cite

Preliminary report of patients with meningiomas exposed to Cyproterone Acetate, Nomegestrol Acetate and Chlormadinone Acetate – Monocentric ongoing study on progestin related meningiomas

Cited by 7 publications

References 48 publications

Risk of intracranial meningioma with three potent progestogens: A population‐based case–control study

Risk of intracranial meningioma with three potent progestogens: A population‐based case–control study

Radiological evolution of progestogen‐induced meningioma: A monocentric retrospective study

Chlormadinone/nomegestrol

Contact Info

Product

Resources

About