A recent randomized controlled trial, as published in The Lancet, has illuminated that the concurrent administration of piroxicam and the levonorgestrel emergency contraceptive pill reduces the rate of unintended pregnancies more effectively than using levonorgestrel alone. The study demonstrated that a 95% prevention rate was achieved through the combination of levonorgestrel and the anti-inflammatory drug piroxicam, in contrast to a 63% rate when levonorgestrel was administered on its own. Though minor side effects were reported, additional investigations are required to clarify piroxicam’s mode of action and its general applicability across various demographic groups.
Levonorgestrel and ulipristal acetate constitute the two primary forms of emergency contraceptive pills, with the former being available in a greater number of countries. Both pharmaceuticals function by either preventing or delaying ovulation and are not efficacious post-ovulation. Levonorgestrel’s established effectiveness is rooted in a 1998 clinical trial, although more recent research intimates that its efficacy may be diminished than previously believed.
Dr. Sue Lo, a co-investigator of the study from the Family Planning Association of Hong Kong, highlighted the significance of identifying an accessible medication that amplifies the effectiveness of levonorgestrel when consumed in unison. Dr. Raymond Li, the study’s lead author from The University of Hong Kong, posited that this initial research implies a more effective form of emergency contraception could be within reach for women globally, pending further investigation and modification of current clinical protocols.
The clinical trial was conducted at a prominent community sexual and reproductive health service in Hong Kong between August 2018 and August 2022. Female participants, who had engaged in unprotected sexual activity within the past 72 hours and required levonorgestrel-based emergency contraception, were randomized to receive a supervised dosage of levonorgestrel and either piroxicam or a placebo. Neither the participants nor the healthcare providers administering the medication were aware of the treatment group assignments. Follow-up appointments were scheduled to confirm pregnancy statuses based on a model established in 1998.
Among the 836 women in the trial, a single pregnancy occurred in the group receiving piroxicam and levonorgestrel, as opposed to seven pregnancies in the placebo group. There were no significant discrepancies in the occurrence of side effects between the two cohorts.
Co-investigator Professor Kristina Gemzell-Danielsson from the Karolinska Institute speculated that piroxicam’s efficacy may derive from its impact on prostaglandins, hormones involved in multiple reproductive processes. Further studies are necessary to substantiate this theory.
The study does present limitations, primarily concerning its generalizability. For instance, women currently or recently using hormonal contraceptives or engaging in multiple episodes of unprotected sex were excluded from the study, casting doubt on the applicability of the findings to these groups.
Dr. Erica Cahill of Stanford University School of Medicine, who did not participate in the study, opined in a related commentary that the combination of piroxicam and levonorgestrel appears promising, although the study’s findings may not be universally applicable given that the study population was primarily of Asian descent and had a body weight below 70 kg.
The study received financial support and was executed by researchers affiliated with the Department of Obstetrics and Gynaecology at The University of Hong Kong.
Reference: “Oral emergency contraception with levonorgestrel plus piroxicam: a randomised double-blind placebo-controlled trial” by Raymond Hang Wun Li, Sue Seen Tsing Lo, Kristina Gemzell-Danielsson, Carol Ho Yi Fong, Pak Chung Ho, and Ernest Hung Yu Ng, published on 16 August 2023 in The Lancet.
DOI: 10.1016/S0140-6736(23)01240-0
Table of Contents
Frequently Asked Questions (FAQs) about Emergency Contraceptive Efficacy
What is the main finding of the recent study published in The Lancet?
The primary finding of the study is that combining the anti-inflammatory drug piroxicam with the emergency contraceptive pill levonorgestrel significantly increases the effectiveness of pregnancy prevention. The prevention rate was 95% with the combination, compared to 63% when levonorgestrel was used alone.
What drugs were compared in this study?
The study compared the effectiveness of levonorgestrel when used alone and when used in combination with piroxicam. A placebo was also administered to a control group.
Where was the study conducted?
The study was carried out at a prominent community sexual and reproductive health service in Hong Kong between August 2018 and August 2022.
Who were the study participants?
The participants were women who had engaged in unprotected sexual activity within the past 72 hours and who sought emergency contraception. They were randomized to receive either levonorgestrel with piroxicam or levonorgestrel with a placebo.
Are there any side effects of using piroxicam with levonorgestrel?
The study reported minimal side effects but emphasized that further studies are required to understand piroxicam’s mechanism of action and its applicability to diverse populations.
What are the limitations of this study?
The study has a few limitations, notably concerning its generalizability. Women currently or recently using hormonal contraceptives or engaging in multiple episodes of unprotected sex were excluded. Also, the study’s participants were primarily of Asian descent and had a body weight below 70 kg.
What implications does the study have for emergency contraception guidelines?
While the study’s findings are promising, further research is needed before any changes in clinical guidelines can be recommended. The hope is that the study will spur additional research that will make more effective emergency contraception available globally.
Who funded and conducted the research?
The study was funded and executed by researchers affiliated with the Department of Obstetrics and Gynaecology at The University of Hong Kong.
Is piroxicam a new drug?
No, piroxicam is not a new drug; it is often prescribed for arthritis pain. This study is the first to suggest that it can enhance the efficacy of levonorgestrel as an emergency contraceptive.
Will this combination treatment be available soon?
The study is an initial step, and further research is required to confirm these findings and to understand the mechanism of action before any changes in clinical guidelines can be made.
More about Emergency Contraceptive Efficacy
- The Lancet Journal
- Emergency Contraception: An Overview
- Piroxicam Medication Information
- Levonorgestrel Information
- Family Planning Association of Hong Kong
- University of Hong Kong Department of Obstetrics and Gynaecology
- Clinical Trials: Understanding Randomized Controlled Trials
6 comments
Isn’t it limited to just one community in Hong Kong? I mean, it’s great but not sure how applicable this is globally.
I wonder how soon this will actually impact clinical guidelines. It’s a good first step but there’s always a long road ahead in medical research.
Questions about generalizability are valid, but you have to start somewhere. If further studies confirm this, it’ll be revolutionary for women’s health.
So they’re saying that an arthritis med can help in contraception too? Wow, science is amazing. Would love to know how it works exactly.
Wow, this is groundbreaking! Always thot that emergency contraceptives were effective enough, but boosting it from 63% to 95% is huge.
Interesting study, but I’m curious about the side effects. it says ‘minimal’ but what does that really mean? Hope they’ll be more specific in future research.