Sickle cell disease: depo-provera contraceptive reduced painful crises.

Clinical bottom line (level 1b)

  1. Women with sickle cell disease who were given depo-provera had fewer painful episodes than those given placebo (NNT = 3 at 14 months) .
  2. Women given depo-provera were less likely to experience bone pain (NNT = 4 at 14 months) .
de Ceulaer et al: Lancet 1982; 2: 229-231
Expires February 2003

The study

Single-blinded ?concealed randomised cross-over trial without intention-to-treat
Setting: university hospital, Jamaica

25 patients (aged range 20 to 41 years, 100% female) homozygous sickle cell disease diagnosed by 'standard criteria'
Note:
  • Women were advised to continue with forms of contraception other than anything steroidal, during the study.


    • Control Group: (n = 23, 23 analysed): saline im once every three months for nine months, followed by six month washout
    Experimental Group: (n = 23, 23 analysed): the contraceptive depo-provera (medroxyprogesterone) 150 mg im every three months for nine months, followed by six month washout period

    100% followed for 14 months

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    bone pain 14 months 20
    (87.0%)    		 14
    (60.9%)    		 30.0%
    (-1.00% to 51.0%)    		 26.1%
    (1.85% to 50.3%)    		 4
    (2 to 54)
    increase in painful crises 14 months 13
    (56.5%)    		 4
    (17.4%)    		 69.0%
    (20.0% to 88.0%)    		 39.1%
    (13.6% to 64.6%)    		 3
    (2 to 7)

  • Severity per episode of painful crises was worse in the depo-provera phase (2 on a severity scale of 1-3), compared with 1.8 with placebo.
  • 26% of women had heavier than normal uterine bleeding- otherwise no other side effects.

    • Citation

    1. de Ceulaer K, Gruber C, Hayes R, et al: medroxyprogesterone acetate and homozygous sickle-cell disease. Lancet 1982; 2: 229-231
    Contributor: Chris Ball and CLare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient sickle cell disease
    Intervention or Exposure depo-povera
    Comparison saline
    Outcome bone pain