Evidence map›Paper›PMID 32550533›Full record

ArticleContraception: X2020

Combined hormonal contraceptive use in Europe before and after the European Commission mandated changes in product information.

Deeksha Khialani, Mary Elizabeth Jones, Szimonetta Komjáthiné Szépligeti, Anne Gulbech Ording, Vera Ehrenstein, Irene Petersen, Astrid van Hylckama Vlieg

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Contraception: X, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.4field-weighted citation impact, top 36% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 5 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 3 countries.

Deeksha KhialaniLeiden University Medical Center, Department of Clinical Epidemiology, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands.
Mary Elizabeth JonesUniversity College London, Department of Primary Care and Population Health, Gower St, Bloomsbury, WC1E 6BT, London, United Kingdom.
Szimonetta Komjáthiné SzépligetiAarhus University, Department of Clinical Medicine - Department of Clinical Epidemiology Olof Palmes Allé 43-45, 8200 Aarhus N, Aarhus, Denmark.
Anne Gulbech OrdingAarhus University, Department of Clinical Medicine - Department of Clinical Epidemiology Olof Palmes Allé 43-45, 8200 Aarhus N, Aarhus, Denmark.
Vera EhrensteinAarhus University, Department of Clinical Medicine - Department of Clinical Epidemiology Olof Palmes Allé 43-45, 8200 Aarhus N, Aarhus, Denmark.
Irene PetersenUniversity College London, Department of Primary Care and Population Health, Gower St, Bloomsbury, WC1E 6BT, London, United Kingdom.
Astrid van Hylckama VliegLeiden University Medical Center, Department of Clinical Epidemiology, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands.
Aarhus University · DKLeiden University Medical Center · NLUniversity College London · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesWe investigated combined hormonal contraceptives (CHC) prescribing patterns (focusing on combined oral contraceptives; COC) in three countries (Netherlands, Denmark, United Kingdom) in a time period preceding and in a time period following the European Commission's decision to update product information, and we estimated changes in incidence of venous thromboembolism (VTE) between the two periods. STUDY

designWe conducted a drug utilization analysis and a cohort study using routinely collected data. We calculated number, proportion and incidence rate of new users, switchers, and stoppers of COC in both time periods. VTE incidence was calculated in new users of COC and in all women aged 18-49 years.

resultsIn all countries, the largest proportion (> 75%) of new users used COC containing levonorgestrel, norethisterone, or norgestimate, (i.e., indicated by European Medicines Agency (EMA) as the safest preparations) in both time periods. Switching did not demonstrate a clear pattern towards these types of COC and distribution of stoppers was similar in both time periods. While the proportion of new users initiating COC containing levonorgestrel, norethisterone, or norgestimate increased slightly, this did not translate to a decrease in the overall VTE incidence.

conclusionAll three countries had the greatest proportion of women initiating a COC containing levonorgestrel, norethisterone, or norgestimate, and this proportion increased in the period after the European Commission decision albeit the increase was small due to the high percentage of use before the decision. This did not translate into a measureable change in the incidence of VTE. IMPLICATIONS: Both before and after the European Commission's decision, the largest proportion of new users started with combined oral contraceptives containing levonorgestrel, norethisterone, or norgestimate. Earlier studies had already indicated an increased risk of VTE associated with COC containing other progestogens compared with these preparations, so it is possible that physicians were already preferentially prescribing COC containing levonorgestrel, norethisterone, or norgestimate to new users.

Indexed as

Combined oral contraceptivesPrescription patternsRiskVenous thromboembolism

Identifiers

PMID32550533
PMCPMC7286180
OpenAlexW2999313492

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.