The association between medroxyprogesterone acetate exposure and cerebral meningioma among a Medicaid population

ABSTRACT BACKGROUND Medroxyprogesterone acetate (MPA) is a synthetic contraceptive that can be used orally or as a once-every-three-month injection (i.e., depot MPA [dMPA]). Prior research has reported an increased association between dMPA and cerebral meningioma, a cancer of the protective layers of the brain. These reported associations have been strongest among prolonged users (i.e., more than two continuous years), but prior research has been limited in generalizability to meningioma cases treated with surgery or cases derived from an administrative database of commercial insurance enrollees. The current study builds upon prior research by examining the association among public insurance enrollees utilizing both a non-active and active comparator. METHODS Utilizing Medicaid data, cases of cerebral meningioma were matched to up to ten controls based on age and year of Medicaid enrollment. A conditional logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between MPA and dMPA exposure and cerebral meningioma compared to both an active and non-active comparator. RESULTS Among 469 cases and 4690 matched controls, there was no association between oral MPA and cerebral meningioma. Associations for dMPA exposure were similar when using a non-active (OR 1.87, 95% CI 1.16-3.00) or active comparator (OR 1.87, 95% CI 0.98-3.56). These associations were strongest for prolonged exposure compared to a non-active (OR 5.40, 95% CI 2.71-10.76) and active comparator (OR 4.01, 95% CI 1.21-13.30). CONCLUSION The current results are consistent with the prior literature that dMPA exposure is associated with an increased likelihood of meningioma for prolonged use. More research is needed to examine whether the association is limited to a certain histology or grade of meningioma. Clinicians should consider discussing with patients these reported associations prior to using dMPA.