Original research article| Volume 95, ISSUE 3, P299-305, March 2017

Prescribing of cyproterone acetate/ethinylestradiol in UK general practice: a retrospective descriptive study using The Health Improvement Network



      To investigate prescribing patterns of cyproterone acetate/ethinylestradiol (CPA/EE) in the United Kingdom before and after the 2013 prescribing guidance.

      Study design

      We conducted a retrospective descriptive study in UK general practice. The study population included women with a first prescription (index date) for CPA/EE in The Health Improvement Network in 2011 (N=2760), 2012 (N=2923) and 2014 (N=2341).
      We evaluated the proportion of new CPA/EE users with (i) a diagnosis of a hyperandrogenic condition, menstrual problem, consultation for contraception management, and other acne treatment, in the year before the index date; and (ii) proportion of new CPA/EE users with concomitant use of another hormonal contraceptive (HC).


      The percentage of CPA/EE new users with a record of a hyperandrogenic condition was 61% in 2011, 62% in 2012 and 63% in 2014. Corresponding percentages for acne were 51%, 54% and 55%, respectively. When manually reviewing patient records for a sample of CPA/EE new users (n=200), the acne was recorded in 77% of women, hirsutism in 9.5% and polycystic ovary syndrome in 9.5%. Majority of CPA/EE users had a prior acne diagnosis and/or treatment, 76% (n=2091) in 2011, 79% (n=2296) in 2012 and 78% (n=1834) in 2014. Concomitant use of CPA/EE and another HC was rare, 1% of CPA/EE users in 2011 and fewer than 0.5% of CPA/EE users in both 2012 and 2014.


      Before and after 2013, the majority of UK women starting treatment with CPA/EE had a condition in line with its approved indication and had received prior acne treatment as per guidance.


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        • CSD Health Research
        ([Accessed 10 October 2016])
        • Stuart-Buttle C.D.
        • Read J.D.
        • Sanderson H.F.
        • Sutton Y.M.
        A language of health in action: read codes, classifications and groupings.
        in: Proc AMIA Annu fall Symp. 1996: 75-79
        • Blak B.T.
        • Thompson M.
        • Dattani H.
        • Bourke A.
        Generalisability of the health improvement network (THIN) database: demographics, chronic disease prevalence and mortality rates.
        Inform Prim Care. 2011; 19: 251-255
        • Lewis J.D.
        • Schinnar R.
        • Bilker W.B.
        • Wang X.
        • Strom B.L.
        Validation studies of The Health Improvement Network (THIN) database for pharmacoepidemiology research.
        Pharmacoepidemiol Drug Saf. 2007; 16: 393-401
        • Cea-Soriano L.
        • García Rodríguez L.A.
        • Machlitt A.
        • Wallander M.A.
        Use of prescription contraceptive methods in the UK general population: a primary care study.
        BJOG. 2014; 121: 53-60
        • Cea Soriano L.
        • Wallander M.A.
        • Andersson S.W.
        • Requena G.
        • García-Rodríguez L.A.
        Study of long-acting reversible contraceptive use in a UK primary care database: validation of methodology.
        Eur J Contracept Reprod Health Care. 2014; 19: 22-28
        • Cea Soriano L.
        • Wallander M.A.
        • Andersson S.
        • Filonenko A.
        • García Rodríguez L.A.
        The continuation rates of long-acting reversible contraceptives in UK general practice using data from The Health Improvement Network.
        Pharmacoepidemiol Drug Saf. 2015; 24: 52-58
        • Cea Soriano L.
        • Wallander M.A.
        • Andersson S.
        • Filonenko A.
        • García Rodríguez L.A.
        Use of long-acting reversible contraceptives in the UK from 2004 to 2010: analysis using The Health Improvement Network database.
        Eur J Contracept Reprod Health Care. 2014; 19: 439-447
        • Cea Soriano L.
        • Soriano-Gabarró M.
        • García Rodríguez L.A.
        Validity and completeness of colorectal cancer diagnoses in a primary care database in the United Kingdom.
        Pharmacoepidemiol Drug Saf. 2016; 25: 385-391
        • Gaist D.
        • Wallander M.A.
        • Gonzalez-Perez A.
        • García Rodríguez L.A.
        Incidence of hemorrhagic stroke in the general population: validation of data from The Health Improvement Network.
        Pharmacoepidemiol Drug Saf. 2013; 22: 176-182
        • Ruigómez A.
        • Martin-Merino E.
        • García Rodríguez L.A.
        Validation of ischemic cerebrovascular diagnoses in The Health Improvement Network (THIN).
        Pharmacoepidemiol Drug Saf. 2010; 19: 579-585
        • Martin-Merino E.
        • Fortuny J.
        • Rivero E.
        • García-Rodríguez L.A.
        Validation of diabetic retinopathy and maculopathy diagnoses recorded in a U.K. primary care database.
        Diabetes Care. 2012; 35: 762-767
        • French R.S.
        • Mercer C.H.
        • Johnson A.M.
        • Fenton K.A.
        • Erens B.
        • Wellings K.
        Use of contraceptive services in Britain: findings from the second National Survey Of Sexual Attitudes And Lifestyles (Natsal-2).
        J Fam Plann Reprod Health Care. 2009; 35: 9-14
        • Cea Soriano L.
        • Wallander M.A.
        • García Rodríguez L.A.
        Prescribing patterns of combined hormonal products containing cyproterone acetate, levonorgestrel and drospirenone in the UK.
        J Fam Plann Reprod Health Care. 2016; 20
        • Seaman H.E.
        • de Vries C.S.
        • Farmer R.D.
        Differences in the use of combined oral contraceptives amongst women with and without acne.
        Hum Reprod. 2003; 18: 515-521
        • Tandy R.M.
        Co-cyprindiol prescribing in a large, rural general practice in England.
        J Fam Plann Reprod Health Care. 2012; 38: 41-43
        • Mintzes B.
        • Morgan S.
        • Bassett K.L.
        Medicine by media: did a critical television documentary affect the prescribing of cyproterone–estradiol (Diane-35)?.
        CMAJ. 2005; 173: 1313-1315
        • Gourbil M.
        • Grandvuillemin A.
        • Beyens M.N.
        • Massy N.
        • Gras V.
        • D'Amico A.
        • et al.
        Thromboembolic events in women exposed to hormonal contraception or cyproterone acetate in 2012: a cross-sectional observational study in 30 French public hospitals.
        Drug Saf. 2014; 37: 269-282