Optimization of contraceptive dosage regimen of Centchroman

Scoping review to map evidence on mechanism of action, pharmacokinetics, effectiveness and side effects of centchroman as a contraceptive pill

OBJECTIVE

To systematically identify and map the available evidence on effectiveness, side effects, pharmacokinetics and mechanism of action of centchroman as a contraceptive pill.

INTRODUCTION

Centchroman was introduced in the Indian national family planning programme in 2016 as a once-a-week short-term contraceptive pill/oral contraceptive. At present there are no WHO recommendations on this method of contraception. We examined the available evidence through a scoping review.

METHODS

A search was conducted inclusive to the years 1970-2019 on electronic databases, grey literature sources and reference lists of included studies to identify studies. The five stages of Arksey and O'Malley's scoping review framework were applied in undertaking this scoping review.

RESULTS

The review identified 33 studies conducted between 1976 and 2017. Two studies reported mechanism of action of centchroman. Pharmacokinetics was reported by five studies among non-breastfeeding women and four studies among breastfeeding women. Eight studies reported on effectiveness ranging from 93% to 100%. Pregnancies due to user failure ranged from 2.6% to 10.2%. Although side effects were reported in 13 studies, the incidence varied greatly between the studies. Continuous bleeding and prolonged cycles >45 days were the most commonly reported side effects. All studies conducted had a small sample size and the duration of follow-up of women was 12 months or less. Fifty-five per cent of studies were by the developers of the pill (Central Drug Research Institute) and results of the phase IV clinical trial were unavailable.

CONCLUSIONS

The scoping review shows that studies with robust designs and conducted in international context are lacking. Insufficient evidence exists on centchroman use as a postcoital contraceptive pill. The broad uncertainty in range of side effects and effectiveness in the studies implies insufficient evidence to make global recommendations on centchroman that is currently licensed as a contraceptive in India.

Effectiveness of Centchroman on Regression of Fibroadenosis and Mastalgia

INTRODUCTION

Fibroadenosis and mastalgia are common among the women in reproductive age group. Treatment for these conditions is not yet standardised. Most of the drugs used for fibroadenosis and mastalgia are expensive and have side effects.

AIM

To find out the efficacy of centchroman, a Selective Estrogens Receptor Modulator (SERM) on regression of fibroadenosis and mastalgia.

MATERIALS AND METHODS

Fifty one patients with mastalgia/fibroadenosis were treated with centchroman 30mg once daily on alternate days for a period of 3 months and followed up weekly for six months with Mastalgia chart and Visual Analog Scale (VAS) pain score.

RESULTS

Before starting treatment, four patients presented with pain score of 6 followed by, 37 patients with a score of 4 and 10 patients with a score of 2. All the patients were started on tab centchroman 30mg OD alternate days and were reviewed on weekly basis with Mastalgia chart and VAS pain score for three months. On fifth and sixth visit, 46 patients reported with pain score 0, one with pain score of 2 and four with pain score of 6. The efficacy of centchroman was found to be significant (p-value = 0.001). Three patients (5.9%) reported epigastric pain and ten patients (19.6%) reported menstrual delay. A total of 38 patients did not complain of any side effect.

CONCLUSION

Our study proves that centchroman is a safe and cost effective drug with significant efficacy on regression of fibroadenosis and mastalgia with minimal side effect.

The role of sevista in the management of dysfunctional uterine bleeding

OBJECTIVE

The complaints of excessive menstrual bleeding (menorrhagia) have a substantial impact on the gynaecological services and in most of the cases, no organic pathology is identified. Nonsteroidal anti-inflammatory drugs and tranexamic acid offer a simple therapy which has to be taken during menses, with reductions of 25-35% and 50% respectively in the Menstrual Blood Loss (MBL). Danazol and the gonadatrophin-releasing hormone analogues are highly effective, but their side-effects make them suitable only for a short-term use. In the present study, the role of ormeloxifene was studied in patients of DUB.

MATERIALS & METHODS

The subjects were diagnosed cases of DUB. After ruling out the possible causes of the abnormal uterine bleeding, a diagnosis of DUB was made and the treatment with ormiloxifene was started. The number of cases were 35 cases. The treatment with ormeloxifene was evaluated by measuring the Hb g/dl and the endometrial thickness before and after 3 months of treatment with sevista. Ormeloxifene was given in the dosage of a 60 mg tablet twice a week for 3 months, followed by once a week for another 3 months.

OBSERVATION & RESULTS

There was a statistically significant increase in the Hb g/dl (p < 0.001) and a statistically significant decrease in the endometrial thickness (p< 0.001) after the treatment with ormeloxifene.

CONCLUSION

Ormeloxifene can be used asa effective drug in the treatment of Dysfunctional uterine bleeding.

Clinical pharmacokinetics and interaction of centchroman--a mini review

This article provides a brief review of the information available regarding the published pharmacokinetics data for the nonsteroidal, once-a-week oral contraceptive, centchroman (INN: ormeloxifene). This agent is a unique need-oriented contraceptive agent which is included in the National Family Welfare Programme of India. Since 1991, centchroman has been used as a need-oriented contraceptive and is being given for treating dysfunctional bleeding of the uterus. Information regarding absorption, tissue distribution, elimination and kinetic interactions is discussed.

Glutaraldehyde cross-linked chitosan microspheres for controlled release of centchroman

Glutaraldehyde cross-linked chitosan microspheres were prepared for controlled release of centchroman, a nonsteroidal contraceptive. The cross-linked microspheres with low-molecular-weight (LMW) chitosan (260 kg mol(-1)) have shown maximum degree of swelling (287 wt%) but were found to be poor in loading and release behavior for centchroman. The microspheres with medium-molecular-weight (MMW) chitosan (1134 kg mol(-1)) have shown 250 wt% degree of swelling and 37.5 wt% loading of centchroman, but microspheres with high-molecular-weight (HMW) chitosan (2224 kg mol(-1)) have shown a low degree of swelling (150 wt%) and centchroman loading (30 wt%). The microspheres with MMW chitosan have released 82 wt% of loaded centchroman in a controlled release manner within a period of 70 h in comparison to low- (260 kg mol(-1)) and high-MW (2224 kg mol(-1)) chitosan microspheres. The chitosan microspheres with 62 wt% degree of deacetylation (DDA) were more efficient in the controlled release of centchroman in comparison to chitosan microspheres with low (48 wt%) and high-DDA (75 wt%). The fractional release of centchroman (M(t)/M(infinity)) from chitosan microspheres was used to predict the mechanism of drug release and to determine the diffusion constant (D) of centchroman.

Weekly contraception with mifepristone

OBJECTIVE

The study investigated the contraceptive effect of weekly administration of mifepristone.

SUBJECTS AND METHODS

A double-blind, randomized clinical trial with weekly doses of 25 or 50 mg of mifepristone was carried out in three centers in China. Women were assigned to either of two groups. We defined each study cycle as 28 days. All bleeding data were derived from women's menstrual cards. The outcome measures were contraceptive efficacy, changes of menstrual pattern and side effects.

RESULTS

Eighty-three women were enrolled and the outcome was known in 76 women: 39 in the 25-mg group and 37 in the 50-mg group. No pregnancy occurred in both groups in 456 women-months of use accumulated. There were no significant differences in mean bleeding days and no bleeding days between the two groups in the first three study cycles. In the fourth, fifth and sixth cycles, mean bleeding days in the 50-mg group (0.86, 1.05 and 0.62, respectively) were significantly less than those in the 25-mg group (3.5, 2.87 and 2.4 respectively); mean no bleeding days in the 50-mg group (26.07, 25.95 and 26.11, respectively) were significantly more than those in the 25-mg group (22.93, 23.23 and 23.51, respectively), and the percentage of women who had no bleeding in a 28-day study cycle in the 50-mg group (22.3%, 25% and 21.1%, respectively) was significantly more than those in the 25-mg group (2.6%, 3.9% and 3.9%, respectively). Side effects, such as nausea and breast distension, were uncommon and mild.

CONCLUSION

Once weekly administration with 25-mg mifepristone is a potentially effective method for regular contraception.

Glutaraldehyde and glyoxal cross-linked chitosan microspheres for controlled delivery of centchroman

Glutaraldehyde and glyoxal cross-linked microspheres were prepared using chitosan with different molecular weights (MWs) and degrees of deacetylation (DDAs) for sustained release of centchroman under physiological conditions. The DDA in chitosan was determined by different methods, and the samples were categorized as chitosan with low (48%), medium (62%), and high (75%) DDA. The size and shape of the microspheres were determined by scanning electron microscopy (SEM), and hydrophobicity was determined by adsorption of Rose Bengal dye on microspheres cross-linked with glutaraldehyde or glyoxal. The effect of MW, DDA, and degree of cross-linking in microspheres was studied on the degree of swelling, as well as by the loading and release of centchroman. The glyoxal cross-linked microspheres were more compact and hydrophobic and showed better sustained release in companion to chitosan microspheres and glutaraldehyde cross-linked microspheres. The linear fractional release of centchroman with the square root of time indicated a Fickian behavior of centchroman, and the microspheres also showed zero-order release kinetics for centchroman.