(P-098) Risk of Intracranial Meningioma Requiring Surgical Intervention Among Recent Hormonal Contraceptives Users

Background: Meningioma accounts for 36.4% of all primary brain and CNS tumors. The effect of sex hormones on the growth and recurrence of meningioma, in particular progesterone and progestins, remains controversial.

Objectives: To investigate the relationship between hormonal contraceptive (HC) exposure and risk for surgically treated intracranial meningioma (SIM) among women of childbearing age.

Methods: This case-control study utilized IBM Marketscan commercial claims data from 2005 to 2018. The study population included female patients age (15-44 years), with ≥ 2 years of continuous enrollment without diagnoses of brain, head and neck malignancies, and neurofibromatosis. Cases of SIM had a diagnosis of intracranial meningioma in combination with a related intracranial surgical intervention. Controls were matched in a ratio of 1:10 based on cohort entry date (±30d) and age(±1y) using risk set sampling. Exposure was assessed from cohort entry date until one year before the index date, to allow for an induction period. Patients were categorized based on hormonal contraceptive (HC) exposure to combined oral contraceptives (COC), progestin only pills (POP), hormonal intrauterine device (IUD), or intramuscular or subcutaneous injectables (IMSC). Multivariate conditional logistic regression was used to estimate odds ratios (OR) while adjusting for obesity, hypertension, sleep apnea, diabetes mellitus type 2, breast cancer, and uterine fibroids.

Results: Among 13,540,092 commercially insured women of childbearing age, we identified 1,900 cases of SIM. The final cohort included 20,900 patients, of whom about 25 % were exposed to any HC during the study period. The frequency of comorbidities differed across contraceptive methods with distinctions most pronounced between COC and POP/ IMSC users. The mean age for cases was 33.6y (±7.5y). Women exposed to COC or IMSC had a 1.25-fold (95% CI 1.10-1.41), and 2.57-fold (95% CI 1.88-3.50) risk of SIM, compared to patients with no recent HC use. POP users had a lower risk for SIM (OR:0.56, 95 % CI 0.32-0.97), and IMSC users had a higher risk for SIM (OR:2.06, 95 % CI:1.49-2.85) compared to COC users.

Conclusions: In this study we found that women with recent exposure to IMSC had a higher risk of SIM when compared to women with recent use of COC or no HC. Further studies with longer follow-up are warranted to validate our findings and evaluate the impact of progestin dose differences on the risk of SIM.