Xiao Tianqi, Kumar Pranav, Lobbous Mina, Yogi-Morren Divya, Soni Pranay, Recinos Pablo F, Kshettry Varun R
Case Western Reserve University School of Medicine, Cleveland, Ohio.
Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Ohio.
JAMA Neurol. 2025 Sep 2. doi: 10.1001/jamaneurol.2025.3011.
There lacks data clarifying the meningioma risk conferred by depot medroxyprogesterone acetate in the US.
To examine the relative risk of meningioma diagnosis in women using depot medroxyprogesterone acetate and other related progestins.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective population-based cohort study used data from TriNetX, a US national database of 68 health care organizations. Data were analyzed from December 2004 to December 2024. The incidence of meningioma diagnosis was compared between treatment groups through propensity-score matched analyses. Participants included a sample of females with use of only 1 of the following progestins/contraceptives: depot medroxyprogesterone acetate, oral medroxyprogesterone acetate, combined oral contraceptives, intrauterine devices, progestin only pills, or subdermal implantable contraceptive. The control group included females without use of these hormonal treatments. Of the 118 289 082 total patients in TriNetX at the time of analysis, 61 588 239 patients were female and eligible.
Patients were defined using diagnostic codes from the International Classification of Diseases, Current Procedural Terminology, and RxNorm codes within TriNetX.
The main outcome was meningioma diagnosis. Relative risks and number needed to harm were calculated.
There were 10 425 438 patients that met inclusion criteria with a mean age of 33.4 years at inclusion. After propensity score matching, 88 667 patients with mean age of 26.2 years at inclusion were in the depot medroxyprogesterone acetate group. Use of depot medroxyprogesterone acetate had a relative risk of 2.43 (95% CI, 1.77-3.33) for meningioma diagnosis compared with controls. Notably, this risk was confined for patients with longer than 4 years of exposure or starting the prescription at ages older than 31 years. Oral medroxyprogesterone acetate had increased relative risk of 1.18 (95% CI, 1.10-1.27) compared with controls. No increased risk of meningioma diagnosis was found with any other contraceptive. The number needed to harm for the depot medroxyprogesterone acetate was 1152 patients and 3020 patients for oral medroxyprogesterone acetate.
In this study, women receiving depot medroxyprogesterone acetate had a greater relative risk of subsequent meningioma diagnosis, especially with prolonged exposures and starting the medication at older ages. The high number needed to harm suggests low clinical risk overall.
在美国，缺乏关于醋酸甲羟孕酮长效注射剂导致脑膜瘤风险的数据。
研究使用醋酸甲羟孕酮长效注射剂及其他相关孕激素的女性患脑膜瘤的相对风险。
设计、背景和参与者：这项基于人群的回顾性队列研究使用了TriNetX（一个由68个医疗保健组织组成的美国国家数据库）的数据。对2004年12月至2024年12月的数据进行了分析。通过倾向得分匹配分析比较了治疗组之间脑膜瘤诊断的发生率。参与者包括仅使用以下一种孕激素/避孕药的女性样本：醋酸甲羟孕酮长效注射剂、醋酸甲羟孕酮口服制剂、复方口服避孕药、宫内节育器、单纯孕激素避孕药或皮下植入式避孕药。对照组包括未使用这些激素治疗的女性。在分析时，TriNetX中的118289082名患者中，有61588239名女性符合条件。
使用TriNetX中的国际疾病分类、当前手术操作术语和RxNorm编码中的诊断代码对患者进行定义。
主要结局是脑膜瘤诊断。计算了相对风险和伤害所需人数。
有10425438名患者符合纳入标准，纳入时的平均年龄为33.4岁。经过倾向得分匹配后，醋酸甲羟孕酮长效注射剂组有88667名患者，纳入时的平均年龄为26.2岁。与对照组相比，使用醋酸甲羟孕酮长效注射剂诊断脑膜瘤的相对风险为2.43（95%CI，1.77 - 3.33）。值得注意的是，这种风险仅限于暴露超过4年或31岁以上开始用药的患者。与对照组相比，醋酸甲羟孕酮口服制剂的相对风险增加至1.18（95%CI，1.10 - 1.27）。使用其他任何避孕药均未发现脑膜瘤诊断风险增加。醋酸甲羟孕酮长效注射剂的伤害所需人数为1152人，醋酸甲羟孕酮口服制剂为3020人。
在本研究中，接受醋酸甲羟孕酮长效注射剂的女性后续患脑膜瘤的相对风险更高，尤其是长期暴露和年龄较大时开始用药的情况。伤害所需人数较多表明总体临床风险较低。
