Efficacy and side-effects profile of the ethinylestradiol and etonogestrel contraceptive vaginal ring: a systematic review and meta-analysis

Abstract

Objective: To assess the efficacy and tolerability (side-effects profile), and compliance of the combined contraceptive vaginal ring (CCVR) compared with combined oral hormonal contraceptives (COC).

Data sources: The PubMed, Embase, POPLINE, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, ClinicalTrials.gov, Clinical Trials Registry Platform (ICTRP) and CINAHL databases were searched.

Methods of study selection: Electronic databases were searched for randomised clinical trials comparing the CCVR with COC with a duration of at least 3 months between 01 December and 15 December 2015. The primary outcome was efficacy. The secondary outcomes were compliance, absence of withdrawal bleeding, breakthrough bleeding, nausea and headache. Heterogeneity was assessed using I² statistic and Cochran's Q statistic. Results were expressed as odds ratios (OR) with 95% confidence intervals (CIs) using random-effects models or fixed-effects models depending on the heterogeneity.

Results: 4368 records were identified, 2844 of which were removed after duplicates and 1524 records were screened. Of these, 1503 were excluded and 21 full text articles were assessed for eligibility. After removing another 7 articles, 14 records were finally included in the qualitative and quantitative analysis. The results show a trend to higher efficacy for the CCVR in preventing pregnancy (Peto OR: 0.52 [95% CI: 0.26–1.04]) and a significantly lower presence of nausea (Peto OR: 0.66 [95% CI: 0.46–0.93]). More cycles were compliant in the CCVR group (Peto OR: 1.22 [95% CI: 1.12–1.32]) and fewer women reported breakthrough bleeding (Peto OR: 0.68 [95% CI: 0.51–0.91]).

Conclusions: Our findings demonstrate that the CCVR is as effective and tolerable as the COC but with a better bleeding profile.

Chinese abstract

目的：评估联合阴道避孕环（CCVR）与组合口服激素避孕药（COC）的疗效, 耐受性（副作用模式）以及依从性。

数据来源：PubMed, Embase, POPLINE, Cochrane对照试验注册中心（CENTRAL）, LILACS, ClinicalTrials.gov, 临床试验注册平台（ICTRP）和CINAHL数据库。

研究筛选方法：搜索电子数据库进行随机临床试验, 将持续时间至少3个月的从12月1日至2015年12月15日的CCVR与COC进行比较。主要结果是疗效。次要结果是依从性, 无撤退性出血, 突破性出血, 恶心和头痛。异质性通过使用I²统计量和Cochran的Q统计量进行评估。结果通过取决于随机效应模型或固定效应模型的异质性的95％置信区间（CI）的比值比（OR）显示。

结果：确定了4368条记录, 其中2844条因重复删除, 在1524条记录中进行筛选。其中, 1503项被排除, 21项全文文章被评估了合格性。在删除了另外7篇文章后, 14个记录最终进行了定性和定量分析。结果显示CCVR具有对避孕更高的效力（Peto OR：0.52 [95％CI：0.26-1.04]）和显著低的恶心反应（Peto OR：0.66 [95％CI：0.46-0.93]）。更多周期的依从于CCVR组（Peto OR：1.22 [95％CI：1.12-1.32]）, 并且较少的妇女报告突破性出血（Peto OR：0.68 [95％CI：0.51-0.91]）。

结论：我们的研究结果表明, CCVR与COC具有相同的有效性和依从性但是具有更好的出血模式。

Keywords:

• Contraceptive vaginal ring
• oral contraceptives
• systematic review
• meta-analysis

Disclosure statement

No external funding was received. There are no conflicts of interest to declare.