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#315 The LARC (long-acting reversible contraception) Song: Is the etonogestrel implant a hit?


CLINICAL QUESTION
QUESTION CLINIQUE
How does the etonogestrel implant (Nexplanon®) compare to other long-acting reversible contraception?


BOTTOM LINE
RÉSULTAT FINAL
Etonogestrel implant (Nexplanon®) is effective with 0-0.34 pregnancies per 100 women per year. In one randomized controlled trial (RCT), the implant had a higher discontinuation rate (27% versus 20%), more amenorrhea (29% versus 9%) and lower patient satisfaction (66% versus 80%) than a low-dose levonorgestrel intrauterine device.



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EVIDENCE
DONNÉES PROBANTES
  • No statistical analysis unless mentioned.
  • One systematic review, 51 studies, only one RCT looking at etonogestrel implant versus other contraception.1 68mg etonogestrel implant (Nexplanon®) versus 13.5mg levonorgestrel intrauterine device (IUD) (Jaydess®) over 12 months (766 women).2
    • Pregnancies: 0 versus 3 (IUD).
    • Discontinuation: 27% versus 20% (IUD) (statistically different), mostly due to adverse events [examples increased bleeding 11% versus 3% (IUD), acne 5% versus 3% (IUD)].
    • Patient satisfaction: 66% versus 80% (IUD) (statistically different).
    • Amenorrhea: 29% versus 9% (IUD).
    • Prolonged bleeding: 16% versus 5% (IUD).
    • “Normal bleeding pattern”: 4% versus 31% (IUD).
    • Limitations:
      • IUD manufacturer funded.
      • Available IUDs in Canada are higher dose.
  • Integrated analysis, 11 non-controlled trials assessed bioequivalent etonogestrel implant (Implanon®) over 2-4 years (942 women, 18-40 years old).3
    • Pregnancy in six women, conception presumed to be following implant extraction (0.34 pregnancies per 100 women per year).
    • Adverse events leading to discontinuation: Bleeding irregularities (11%), emotional lability (2%), weight gain (2%), headache (2%), acne (1%), and depression (1%).
    • Insertion and removal complications 1% and 2%, respectively.
    • Limitations: Industry funded, not a systematic review.
  • Non-comparative trial of etonogestrel implant (Nexplanon®) for 3 years (301 women, mean age 28) found similar efficacy and adverse events.4
    • Average weight gain 1.4kg at 36 months.
  • Similar efficacy5 and insertion/removal complications6 in observational studies.
Context
  • Nexplanon® is a subcutaneous, radio-opaque, matchstick-sized flexible rod that lasts 3 years.7,8
    • Costs ~$310 versus ~$370 for hormonal IUDs which last 5 years.7
  • Training required for insertion and removal.8
  • Cases of pulmonary migration, infections, barium allergic reactions, and insertion-related neuropathies have been reported.9 No effect observed on bone mineral density.10,11


Paul Salciccioli May 22, 2022

Another patient option

Heather Cuddy May 26, 2022

Definitely an option for young women who are nervous about getting an iud

Janet Strome May 30, 2022

Good information. I hadn’t heard of this.


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Author(s)
Auteur(s)
  • Nicolas Dugré PharmD MSc BCPAC
  • Nidhi Choksi BScPharm
  • Jessica Kirkwood MD CCFP (AM)

1. Moray KV, Chaurasia H, Sachin O, et al. Reprod Health. 2021; 18(1):4.

2. Apter D, Briggs P, Tuppurainen M, et al. Fertil Steril. 2016; 106(1):151-157.e5.

3. Darney P, Patel A, Rosen K, et al. Fertil Steril. 2009; 91(5):1646-53.

4. Mommers E, Blum GF, Gent TG, et al. Am J Obstet Gynecol. 2012; 207(5): 388.e1-6.

5. Winner B, Peipert JF, Zhao Q, et al. N Engl J Med. 2012; 366(21):1998-2007.

6. Reed S, Do Minh T, Lange JA, et al. Contraception. 2019; 100(1):31-36.

7. Be Ready to Answer Questions About Nexplanon Contraceptive Implant. Pharmacist's Letter Canada. October 2020, No. 361018. https://ca-pharmacist.therapeuticresearch.com/Content/Articles/PLC/2020/Oct/Be-Ready-to-Answer-Questions-About-Nexplanon-Contraceptive-Implant (Accessed Feb 17, 2022).

8. Organon Canada. Product monograph: Nexplanon. April 2021. https://www.merck.ca/static/pdf/NEXPLANON-PM_E.pdf (Accessed Feb 17, 2022).

9. Rocca ML, Palumbo AR, Visconti F, et al. Pharmaceuticals (basel). 2021; 14(6):548.

10. Beerthuizen R, van Beek A, Massai R, et al. Human Reproduction. 2000; 15(1):118-22.

11. Modesto W, Dal Ava N, Monteiro I, et al. Arch Gynecol Obstet. 2015; 292(6):1387-91.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.