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Articles: Jill P. Buyon, Michelle A. Petri, Mimi Y. Kim, Kenneth C. Kalunian, Jennifer Grossman, Bevra H. Hahn, Joan T. Merrill, Lisa Sammaritano, Michael Lockshin, Graciela S. Alarcón, Susan Manzi, H. Michael Belmont, Anca D. Askanase, Lisa Sigler, Mary Anne Dooley, Joan Von Feldt, W. Joseph McCune, Alan Friedman, Jane Wachs, Mary Cronin, Michelene Hearth-Holmes, Mark Tan, and Frederick Licciardi The Effect of Combined Estrogen and Progesterone Hormone Replacement Therapy on Disease Activity in Systemic Lupus Erythematosus: A Randomized Trial Ann Intern Med 2005; 142: 953-962 [Abstract] [Full text] [PDF]

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Hormone replacement therapy and systemic lupus erythematosus

Carlos Abud-Mendoza, Lourdes Baranda   (28 July 2005)

Hormone replacement therapy and systemic lupus erythematosus 28 July 2005
Carlos Abud-Mendoza, M.D. Hospital Central, and Facultad de Medicina, UASLP, San Luis Potosí, S.L.P., México, Lourdes Baranda Send rapid response to journal: Re: Hormone replacement therapy and systemic lupus erythematosus c_abud{at}hotmail.com Carlos Abud-Mendoza, et al.	To the editor: In a recent study on hormone replacement therapy (HRT) in menopausal patients with systemic lupus erythematosus (SLE), Buyon et al. concluded that the benefits of HRT can be balanced against the small risk for flare (1). They claim that there are undisputed health benefits of HRT, and do not discuss the higher frequency of serious adverse events in the HRT group (1 death, 1 stroke, and 3 thrombosis events) compared to the placebo group (1 thrombosis event). We disagree with the conclusions of this study, mainly because it seems clear that female patients with SLE have proclivity to endothelial activation and thrombogenic events, specially those with active disease (2). In addition, it has been reported that healthy postmenopausal women under HRT have an absolute excess risk of 7 more coronary heart disease events, 8 more strokes, and 8 more pulmonary embolisms (3). The unavoidable conclusion of this 5.2-year follow-up study is that the risks of HRT clearly exceed their putative benefits. In fact, it is evident that the cardiovascular risk of women under HRT is higher than that of patients receiving the selective COX-2 inhibitor Rofecoxib (4). Our concern is further supported, in the case of SLE patients, by the work of Sanchez-Guerrero et al.,(5) who in a controlled clinical trial found 2 deaths in the group under HRT, and none in patients receiving placebo. Furthermore, it is also evident that the putative benefits of HRT, require its sustained administration, increasing thus the risk of adverse events. Therefore, we think that HRT is not a suitable option for the therapy of menopausal associated symptoms in SLE, even in short-term administration. It seems evident for us that the significantly increased risk of flares, the higher frequency of serious adverse events (although no significant from a statistical point of view in the study of Buyon et al.) associated to HRT, and its not yet proved beneficial effects in SLE patients, must preclude its use in these patients. Alternative therapies for menopausal symptoms should be attempted in these patients. Carlos Abud-Mendoza, M.D. Lourdes Baranda, M.D. Hospital Central “Dr. Ignacio Morones Prieto”, and Facultad de Medicina, UASLP 78210 San Luis Potosí, S.L.P. México c_abud@hotmail.com baranda@uaslp.mx Potencial financial conflicts of interest: None disclosed References 1. Buyon JP, Petri MA, Kim MY, Kalunian KC, Grossman J, Hahn BH, Merrill JT, Sammaritano L, Lockshin M, Alarcon G, et al. The effect of combined estrogen and progesterone hormone replacement therapy on disease activity in systemic lupus erythematosus: A randomized trial. Ann Intern Med 2005; 142: 953-62. 2. Toloza SMA, Uribe AG, McGwin G, Alarcón GS, Fessler BJ, Bastian HM, Vilá LM, et al. Systemic lupus erythematosus in a multiethnic US cohort (LUMINA): XXIII. Baseline predictor of vascular events. Arthritis Rheum 2004; 50: 3947-57. 3. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled clinical trial. JAMA 2002; 288: 321-33. 4. Bresalier RS, Sandler RS, Quan H, Bolognese JA, Oxenius B, Horgan K, et al, and the Adenomatous Polyp Prevention on Vioxx (APPROVe) Trial Investigations. Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med 2005; 352: 1092- 102. 5. Sanchez-Guerrero J, Gonzalez-Perez M, Durand-Carbajal M, Lara-Reyes P, Bahena-Amezcua S, Cravioto MC. Effect of hormone replacement therapy (HRT) on disease activity in postmenopausal patients with systemic lupus erythematosus. Arthritis Rheum 2001; 44: S263. Conflict of Interest: None declared