Yael Shalev Rosenthal1, Gabi Chodick1,2, Adam Rosenthal1, Varda Shalev1,2, Hila Shalev Ram1, Gideon Koren3,4,5. 1. Maccabi-Kahn Institute of Research and Innovation, 4 Koifman st, 8th floor, 6812509, Tel Aviv, Israel. 2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Maccabi-Kahn Institute of Research and Innovation, 4 Koifman st, 8th floor, 6812509, Tel Aviv, Israel. gidiup_2000@yahoo.com. 4. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. gidiup_2000@yahoo.com. 5. Adelson Faculty of Medicine, Ariel University, Ariel, Israel. gidiup_2000@yahoo.com.
Abstract
BACKGROUND: Oral contraceptives (OCs) are one of the most commonly used classes of drugs worldwide. A case of neutropenia and associated infections in a young woman using OCs that settled after discontinuation and reappeared upon re-challenge, has led us to investigate a potential association between oral contraceptives and neutropenia. OBJECTIVES: To compare rates of neutropenia among women receiving OCs to a matched control group of women not exposed to the "pill". PATIENTS AND METHODS: In this population-based cohort study we used a large computerized database of a health fund, comparing women prescribed OCs and a control group not using the pill. We selected a cohort of 51,394 OC users aged 16-40 years who purchased their first monthly pack of OCs between 2010 and 2018. Controls included all non-pregnant women aged 16-40 years for whom OC was not dispensed (n = 140,932). Neutrophil count before and during OC were compared. RESULTS: Prior to OC exposure, 1.3% of the women were neutropenic, compared to 1.6% after exposure to OC (RR 1.22; 95% CI 1.1-1.35). Mean neutrophil count changed from 3.87 × 103 to 3.82 × 103 mm3 (p < 0.001). In the control group (n = 140,932) no difference was seen in the proportion of neutropenic women between the first complete blood count (1.7%) compared to the second (1.8%) count (p = 0.305). In all severity levels, neutropenia was significantly more common in the OC group. The relative risk was higher for severe (RR 1.63) than for mild neutropenia (RR 1.13) (p = 0.034 for trend). CONCLUSIONS: There is a significant increase in the proportion of neutropenic women after initiating OCs. More research is needed in order to evaluate the effect of neutropenia in this group of women.
BACKGROUND: Oral contraceptives (OCs) are one of the most commonly used classes of drugs worldwide. A case of neutropenia and associated infections in a young woman using OCs that settled after discontinuation and reappeared upon re-challenge, has led us to investigate a potential association between oral contraceptives and neutropenia. OBJECTIVES: To compare rates of neutropenia among women receiving OCs to a matched control group of women not exposed to the "pill". PATIENTS AND METHODS: In this population-based cohort study we used a large computerized database of a health fund, comparing women prescribed OCs and a control group not using the pill. We selected a cohort of 51,394 OC users aged 16-40 years who purchased their first monthly pack of OCs between 2010 and 2018. Controls included all non-pregnant women aged 16-40 years for whom OC was not dispensed (n = 140,932). Neutrophil count before and during OC were compared. RESULTS: Prior to OC exposure, 1.3% of the women were neutropenic, compared to 1.6% after exposure to OC (RR 1.22; 95% CI 1.1-1.35). Mean neutrophil count changed from 3.87 × 103 to 3.82 × 103 mm3 (p < 0.001). In the control group (n = 140,932) no difference was seen in the proportion of neutropenicwomen between the first complete blood count (1.7%) compared to the second (1.8%) count (p = 0.305). In all severity levels, neutropenia was significantly more common in the OC group. The relative risk was higher for severe (RR 1.63) than for mild neutropenia (RR 1.13) (p = 0.034 for trend). CONCLUSIONS: There is a significant increase in the proportion of neutropenicwomen after initiating OCs. More research is needed in order to evaluate the effect of neutropenia in this group of women.
Authors: M Casato; L P Pucillo; M Leoni; L di Lullo; A Gabrielli; D Sansonno; F Dammacco; G Danieli; L Bonomo Journal: Am J Med Date: 1995-10 Impact factor: 4.965
Authors: Marcos de Bastos; Bernardine H Stegeman; Frits R Rosendaal; Astrid Van Hylckama Vlieg; Frans M Helmerhorst; Theo Stijnen; Olaf M Dekkers Journal: Cochrane Database Syst Rev Date: 2014-03-03
Authors: A J M Nieuweboer; M Smid; A-J M de Graan; S Elbouazzaoui; P de Bruijn; F A L M Eskens; P Hamberg; J W M Martens; A Sparreboom; R de Wit; R H N van Schaik; R H J Mathijssen Journal: Pharmacogenomics J Date: 2015-09-08 Impact factor: 3.550