Need for Access to Contraception Still Unmet for Many Women
The Family Planning 2020 Initiative set a goal of increasing the number of women using modern contraceptives by 120 million in priority countries. A new report in The Lancet estimates that this number increased by 69 million in these countries, which would fall 51 million short of that goal. In the study, part of the systematic analysis for the Global Burden of Disease Study 2019, higher rates of contraceptive coverage were linked with the availability of a diverse range of contraceptive choices. This study elucidates the major increases in contraceptive use and the reductions in unmet need that have occurred since 1980.
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Researchers examined 1,162 population-based surveys of contraceptive use by women of reproductive age (ages 15 to 49) who self-reported current use of contraceptives for family planning. Using regression analysis, they determined estimates of the contraceptive prevalence rate (CPR) and modern CPR (mCPR), whether the demand for contraception was satisfied, and the contraceptive method mix, and examined them in both partnered and unpartnered women in five age groups.
Between 1970 and 2019, increases were observed in use of all contraceptives (CPR), increasing by 18.7 percentage points, and that of mCPR, by 20.1 percentage points. The demand satisfied increased by 24.3 percentage points. In 2019, the average CPR was 51.9%, average of mCPR was 47.7%, and demand satisfied was 79.1%, although there were considerable differences geographically.
Women ages 15 to 24 accounted for 16.0% of total need but 26.5% of global unmet need. The lowest rate of demand satisfied was found in women ages 15 to 19 (64.8%), followed by those ages 20 to 24 (71.9%); 43.2 million women ages 15 to 24 had unmet needs for contraception in 2019. These lower rates of satisfied demand in young women are cause for concern because of the effects both on the women themselves and society in general. Use of contraception is associated with reductions in maternal and neonatal mortality due to the avoidance of unintended and adolescent pregnancies, and access to contraceptives supports pursuit of education and economic opportunities. To address these disparities, family planning programs must determine the accessibility and acceptance of existing methods in use by other women among this younger age group.
The methods women used to meet their contraception needs differed by marital status, age, and region. Compared with partnered women of all ages, unpartnered women more commonly used oral contraceptive pills and condoms; long-acting reversible methods (such as, IUDs, contraceptive implants, or injections) tended to be used most by women ages 20 to 49, and older women were more likely to use female sterilization.
The absence of contraceptives tailored to the needs of younger women might be one explanation for the unmet need in that population; for example, if female sterilization is the method most often available, it’s unlikely to appeal to young women who haven’t had children yet. (Haakenstad, A., et al. (2022). Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 400(10348), 295–327. Retrieved July 2022 from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00936-9/fulltext#seccestitle210)
Released: August 2022
Nursing Drug Handbook
© 2022 Wolters Kluwer
Macrolide Antibiotics May Be Associated with Hearing Loss in Children
Macrolides are one of the most used medications in children, with the most frequently prescribed being azithromycin, clarithromycin, and erythromycin. A retrospective case-control study published in JAMA Otolaryngology–Head and Neck Surgery attempted to determine whether that outpatient macrolide treatment was associated with pediatric sensorineural hearing loss. Past research has linked sensorineural hearing loss in adults to prior use of high-dose or IV macrolide treatment, but it hasn’t been studied in children.
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Using data from TRICARE, the health insurance system for U.S. uniformed service members and their families, the study analyzed 875 matched pairs of children, adolescents, and young adults with and without sensorineural hearing loss from records of outpatient encounters from October 2009 to September 2014. They were matched by age, sex, and time elapsed since the date of antibiotic prescription. Mean age was 5.7 years; patients were 62% male, and 66% non-Hispanic white. Multivariate logistic regression was used to compare the risk of prior macrolide exposure with penicillin exposure, adjusted for other risk factors and potential confounders.
They found that compared with peers without hearing loss, pediatric patients with sensorineural hearing loss were more likely to have received a prescription for a macrolide antibiotic compared to one for penicillin (adjusted odds ratio [aOR], 1.31). The odds were significantly higher when more than 180 days had elapsed between antibiotic exposure and the patient’s testing and diagnosis of hearing loss (aOR, 1.79).
Currently, 56% of pediatric sensorineural hearing loss is considered idiopathic; this study suggests that macrolides warrant further study as potential risk factors. The results could also guide practice by encouraging early recognition of sudden hearing loss after macrolide use, given the success rate of prompt hyperbaric oxygen treatment for these patients. (Lopilato, J. (2022). Kids’ hearing loss associated with common antibiotics. MedPage Today. Retrieved July 2022 from https://www.medpagetoday.com/pediatrics/generalpediatrics/99855; Dabekaussen, K. F., et al. (2022). Association of outpatient oral macrolide use with sensorineural hearing loss in children, adolescents, and young adults. JAMA Otolaryngol—Head Neck Cancer. Retrieved July 2022 from https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2794472?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF)
Released: August 2022
Nursing Drug Handbook
© 2022 Wolters Kluwer
Ontamalimab Showed Sustained Treatment Response in Crohn Disease
In a substantial number of patients with Crohn disease, nonresponse or loss of response to the approved treatments results in an unmet need for novel treatments with a good safety profile and more durable efficacy. OPERA-II, a multicenter, open-label phase 2 extension study, examined the long-term safety and efficacy of one of these treatments, ontamalimab, a fully human IgG monoclonal antibody against mucosal addressin cell adhesion molecule-1.
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All patients in the study had completed 12 weeks of treatment in OPERA, a phase 2, double-blind, placebo-controlled trial that examined three dosage strengths of ontamalimab (22.5 mg, 75 mg, or 225 mg) and compared clinical response and remission in 265 patients with Crohn disease, or had had a clinical response to a 225-mg dose of ontamalimab in another study, TOSCA, a 12-week, open-label study in which ontamalimab was given to 39 patients with active Crohn disease who had previously received immunosuppressants. In OPERA, clinical response and remission were observed in greater proportions of patients in the treatment group than with placebo, although these differences hadn’t reached statistical significance, and in TOSCA, 80% of treated patients had a clinical response and 77% were in clinical remission at week 12.
Conducted from July 2011 through July 2016 in 81 centers in 15 countries worldwide, OPERA-II examined safety (adverse events and serious adverse events) and efficacy (clinical remission and response rates at weeks 24 and 72, the rate of relapse and time to relapse, the proportions of patients with changes in dosage, and proportion who discontinued by week 16) outcomes in patients with moderate to severe Crohn with a history of failed immunosuppressant therapy. Participants received ontamalimab at 75 mg every 4 weeks for 72 weeks, and then were followed up every 4 weeks for 24 weeks. Dosage could be decreased to 22.5 mg for intolerance or adverse events or increased to 225 mg in patients with inadequate response.
Overall, 149 of 268 patients completed the study; 74 patients discontinued during the study period and another 45 during follow-up. The most common event leading to discontinuation was disease flare, in 19.8% of patients; 2 patients died, no patients required dosage reductions, and 157 had dosage escalations. Median time to dosage escalation was 28 weeks. Of the 68 patients who required dosage escalation by week 8, 13 subsequently discontinued the study by week 16. During the treatment period, 249 patients reported a total of 1,550 adverse events, of which 385 were considered treatment related. During the follow-up period, 133 patients experienced a total of 461 adverse events, of which 42 were treatment related.
Rates of clinical remission of Crohn disease, defined as a score on the Harvey Bradshaw index (HBI) less than or equal to 5, was 48.1% at baseline, 47.8% at the end of week 24 of follow-up, and 37.3% at week 72. Of the 128 patients who were not in remission at baseline, 84 achieved remission during the study, with a median time to remission of 16.9 weeks. Similar results were seen in response, as measured by decreases in HBI greater than or equal to 3 points; at baseline the response rate was 63.1%, at week 24 it was 54.5%, and by week 72 was 42.5%. Of the 99 patients who hadn’t demonstrated clinical response at baseline, 68 did so during the study, with a median time to response of 13.9 weeks. In those who received the higher, 225-mg dose, the proportion of those in remission remained relatively stable from week 12 (31.8%) to week 72 (32.2%). Relapse was defined as an increase greater than or equal to 3 points in HBI score from the lowest HBI score measured, with a total HBI score greater than or equal to 8. Of the 226 patients who had experienced clinical response at any time during the study, 119 (52.7%) experienced relapse, with the median time to relapse of 67.4 weeks. (D’Haens, G. R., et al. (2022). Long-term safety and efficacy of the anti-mucosal addressin cell adhesion molecule-1 monoclonal antibody ontamalimab (SHP647) for the treatment of Crohn’s disease: The OPERA II study. Inflamm Bowel Dis, 28(7), 1034–1044. Retrieved July 2022 from https://academic.oup.com/ibdjournal/article/28/7/1034/6357026#363711481)
Released: August 2022
Nursing Drug Handbook
© 2022 Wolters Kluwer