Etonogestrel-releasing contraceptive implant in a patient using thalidomide for the treatment of erythema nodosum leprosum: a case report

Abstract

Introduction

Thalidomide is an immunomodulatory drug and first choice in the treatment of erythema nodosum leprosum. Given its teratogenic potential, it is essential that an effective contraceptive method is used, especially a long-acting reversible contraceptive (LARC) method. The subdermal etonogestrel (ENG)-releasing implant is an adequate method due to the high effectiveness and long-term use. However, interaction between thalidomide and ENG has not been well documented. Concern arises because thalidomide interacts with cytochrome P450 (CYP450) enzymes that metabolize sexual steroids. AIM: We aimed to study the effectiveness and safety of the ENG-implant in a thalidomide user.

Methods

Case report of a sexually active 21-year-old patient with both Hansen’s disease and leprosy reaction type 2 treated with thalidomide requiring effective contraception. Follow-up was up to 36 months after implant placement.

Results

Contraception with ENG-implant was effective and safe, based on clinical parameters (reduction of menstrual flow and cervical mucus thickening) and laboratory parameters (gonadotropins and sexual steroids).

Conclusion

To the best of our knowledge, this is the first case reported which presents a patient in simultaneous use of thalidomide and ENG-implant. Although this case report preliminary supports effectiveness and safety of ENG-implant as a contraceptive option in women using thalidomide, rigorous drug-drug interaction research is needed to better characterize the interaction between thalidomide and the ENG-implant.

麻风结节性红斑服沙利度胺治疗的患者用依托孕烯植入物避孕：个案报告 摘要

背景：沙利度胺是一种免疫调节药物, 是治疗麻风性结节性红斑的首选药物。鉴于其致畸可能, 必须采用有效的避孕方法, 特别是长效可逆的避孕方法（LARC）。皮下释放依托孕烯（ENG）的植入物是一种适当的方法, 因为其有效性高且可长期使用。然而, 沙利度胺和ENG的相互作用还未很好的揭示。由于沙利度胺与性甾体激素代谢的细胞色素P450（CYP450）酶有相互作用, 因此产生了担忧。

目的：我们旨在研究沙利度胺使用者的ENG-植入物的有效性和安全性。

方法：一例性活跃的21岁应用沙利度胺治疗的汉森病和II型麻风反应患者需要有效避孕, 术后随访36个月。

结果：根据临床指标（月经量减少和宫颈粘液增厚）和实验室检查（促性腺激素和性激素）, ENG植入物避孕是有效和安全的。

结论：据我们所知, 这是第一例报道同时应用沙利度胺和ENG植入物的患者。虽然本病例报告初步支持ENG植入物作为沙利度胺治疗女性的避孕选择的有效性和安全性, 但需要进行严格的药物相互作用研究, 以更好地描述沙利度胺和ENG植入物之间的相互作用。

Keywords:

• Thalidomide
• leprosy
• etonogestrel
• subdermal implant
• contraceptive agents
• case report

Ethics approval and consent to participate

For this case report, we followed declaration of Helsinki of ethical principles for medical research involving human subjects. Approval of the Institutional Ethics Review Board was waived because it was a case report.

Consent for publication

Written consent of the patient was obtained for the report and for all the photos.

Author contributions

All authors have participated sufficiently in the work to take public responsibility for the content. ESFF and ICES participated in the concept, design, and writing of the manuscript; DCD and PGA participated in the data collection and writing of the manuscript; LB, ALG, JMSJ and ECB participated in its revision. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published elsewhere. All authors approved the final version of the manuscript to be published. The paper is not under consideration at another journal; there are no publications using the same material.

Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Disclosure statement

No potential conflict of interest was reported by the author(s).