5. The progestogen Drospirenone (DRSP) resembles
natural progesterone more than any other synthetic
progestogen contained in currently marketed pills:
antimineralocorticoid effect = counteracts water
retention
no androgenic effect = beautiful skin
What is special ?
7. However
often allow follicular development
23 - 37% of cycles have follicles >13 mm
with 30 µg EE*
Up to 60% of cycles have follicles >13 mm
with 20 µg EE*
8. Traditionally
Traditional forms of OCP contain 21 days
of hormone-containing pills and 7 days of
placebo during the hormone-free interval
(HFI).
Menses usually starts within 48hrs
Start OCP again on CD5
21/7
9. However
The increase in FSH during the pill-free
interval is responsible for follicular growth
and estradiol production
13. YAZ® effectively inhibits follicular
development
Cycle 21
Correct dosing regimen
Mean
follicle
size
(mm)
12
10
8
6
4
2
0
2
4
6
8
10
12
12
10
8
6
4
2
0
2
4
6
8
10
12
Mean
follicle
size
(mm)
1Klipping C, et al. Contraception 2008; 78: 16–25; 2Bayer HealthCare
Pharmaceuticals, data on file (protocol number 308382)
YAZ® Yasminelle®
14. YAZ® effectively inhibits follicular
development
Mean
follicle
size
(mm)
12
10
8
6
4
2
0
2
4
6
8
10
12
12
10
8
6
4
2
0
2
4
6
8
10
12
Mean
follicle
size
(mm)
Cycle 31
3 intentionally missed pills at beginning of cycle
1Klipping C, et al. Contraception 2008; 78: 16–25; 2Bayer HealthCare
Pharmaceuticals, data on file (protocol number 308382)
YAZ® Yasminelle®
15. So 24/4 concept
Shortening the hormone-free interval to 3
or 4 days results in greater inhibition
follicular development and suppression of
ovarian steroid synthesis
16. EE-Dprs
24/4 regimen provides 3 extra days of anti-
mineralocorticoid and antiandrogenic
activity per 28-day cycle relative to
conventional 21+7 day OCs Blode H, et al. 2000
17. S.E
The shortened HFI interval with the 24/4
regimen could minimize hormone-
withdrawal symptoms that may occur with
conventional regimens
i.e. headaches, cramps, breast
tenderness and bloating/swelling
19. Extended-contraceptive regimen delays
menses and reduces bleeding, a profile
that may be preferred by women who
seek flexibility with their contraceptive
method Bustillos-Alamilla 2010
21. Effectiveness of YAZ® in a real-life
setting: INAS-OC study outline (1)
Design1
• Prospective, controlled, active surveillance, noninterventional cohort
study in the USA and 6 European countries
• Participants recruited via an international network of gynecologists
• Follow-up via direct contacts with study participants
Cohorts1
• EE/drospirenone in a 24/4 regimen, e.g. YAZ®, EE/drospirenone in a
21/7 regimen, e.g. Yasmin®, OCs containing progestins other than
drospirenone
EE = ethinylestradiol; INAS-OC = International Active Surveillance Study on Oral
Contraception; OC = oral contraceptive
1Dinger J, et al. BMC Med Res Methodol 2009; 9: 77
22. Effectiveness of YAZ® in a real-life
setting: INAS-OC study outline (2)
Sample Size1
• >85,000 OC users (52,218 US; 33,042 Europe)
• >220,000 WY of exposure
Study Period1
• 2005 to 2012
INAS-OC = International Active Surveillance Study on Oral Contraception;
OC = oral contraceptive; WY = women-years
1Dinger J, et al. BMC Med Res Methodol 2009; 9: 77
23. Effectiveness of YAZ® in a real-life
setting: INAS-OC study objectives
Study objectives1
• To compare cardiovascular safety of EE/drospirenone in a
24/4 regimen, e.g. YAZ®, to established OCs during standard clinical
practice (e.g., DVT, PE, AMI, stroke)
• To investigate incidence of rare SAEs associated with use of
EE/drospirenone in a 24/4 regimen, e.g. YAZ®, and established OCs
• To investigate contraceptive failure rates associated with use of
EE/drospirenone in a 24/4 regimen, e.g. YAZ®, EE/drospirenone in a
21/7 regimen, e.g. Yasmin®, and OCs containing progestins other than
drospirenone
AMI = acute myocardial infarction; DVT = deep vein thrombosis; EE = ethinylestradiol;
INAS-OC = International Active Surveillance Study on Oral Contraception; OC = oral
contraceptive; PE = pulmonary embolism; SAE = serious adverse event
1Dinger J, et al. BMC Med Res Methodol 2009; 9: 77
24. Effectiveness of YAZ® in a real-life setting:
INAS-OC contraceptive effectiveness findings (1)
Contraceptive failure was assessed in 52,218 US participants with 1,634
unintended pregnancies during 73,269 WY of OC use (interim data)1
YAZ® cohort showed the lowest contraceptive failure rate1
Lower rate of contraceptive failure was even more pronounced in
adolescents:2
• Pearl Index for 24/4 regimens: 2.5 (95% CI 2.1–2.9)
• Pearl Index for 21/7 regimens: 5.1 (95% CI 3.7–6.8)
CI = confidence interval; EE = ethinylestradiol; OC = oral contraceptive; WY = women-years
1Dinger J, et al. Obstet Gynecol 2011; 117(1): 3340;
2Dinger J. J Fam Plann Reprod Health Care 2011; 37(2): 118
OC Pearl Index (95% CI)
Overall 2.2 (2.1–2.3)
EE 20 µg/drospirenone 3 mg in a 24/4 regimen, e.g. YAZ® 1.6 (1.4–1.9)
EE 30 µg/drospirenone 3 mg in a 21/7 regimen, e.g. Yasmin® 2.2 (1.8–2.6)
Other OCs containing progestins other than drospirenone 2.6 (2.4–2.7)
25. Effectiveness of YAZ® in a real-life setting:
INAS-OC contraceptive effectiveness findings (2)
Adjusted hazard ratio = 0.7 (95% CI 0.6–0.8) for EE 20 µg/drospirenone 3 mg
in a 24/4 regimen, e.g. YAZ®, versus EE 30 µg/drospirenone 3 mg in a 21/7
regimen, e.g. Yasmin®1
EE 20 µg/drospirenone 3 mg in a 24/4 regimen, e.g. YAZ®, had the highest
contraceptive effectiveness during routine usage1
INAS-OC, a large post-approval study under real-life conditions,
shows that YAZ® has high contraceptive effectiveness1
CI = confidence interval; EE = ethinylestradiol; OC = oral contraceptive
1Dinger J, et al. Obstet Gynecol 2011; 117(1): 3340
YAZ® is a low-dose contraceptive pill containing EE 20 µg and drospirenone 3 mg that is administered in cycles of 24 days of active pills followed by 4 hormone-free days (24/4 regimen).
The shortened HFI of the 24/4 regimen provides 3 additional days of EE 20 µg/drospirenone 3 mg with antimineralocorticoid and antiandrogenic activity per 28-day cycle.
Moreover, the approximate 30-hour half-life of drospirenone extends its unique activity into the shortened HFI.1,2
1Blode H. Pharmacokinetics of drospirenone. Gynaecology Forum 2002; 7(1): 1822
2Blode H, Wuttke W, Loock W, et al. A 1-year pharmacokinetic investigation of a novel oral contraceptive containing drospirenone in healthy female volunteers. Eur J Contracept Reprod Health Care 2000; 5(4): 25664
For the full analysis set and the per-protocol set, the mean value for the maximum follicle size over all visits followed a similar pattern for both treatments with a slightly stronger suppression of follicle development in cycles 2 and 3 for YAZ® compared to the 21-day regimen (Yasminelle®).1
For YAZ®, the mean value for the maximum follicle size was 18.68 mm (SD 3.77) at pre-treatment and decreased noticeably at cycle 2 (8.32 mm, SD 2.41). For cycle 3, the 3 intentionally missed tablets at the beginning of the cycle led to an increase in the mean maximum follicle size compared to cycle 2 (cycle 3: 12.59 mm, SD 6.33). At post-treatment, values recovered and were comparable to pretreatment values (post-treatment: 20.43 mm, SD 3.74).1,2
For Yasminelle®, the mean value for the maximum follicle size was 19.87 mm (SD 4.23) at pretreatment and decreased at cycle 2 to 12.29 mm (SD 7.04). This decrease of mean maximum follicle size at cycle 2 was less pronounced compared to the 24-day regimen. For cycle 3, the 3 intentionally missed tablets at the beginning of the cycle led to an increase in the mean value for the maximum follicle size compared to cycle 2 (cycle 3: 16.90 mm, SD 7.90). At post-treatment, values recovered and were comparable to pretreatment values.1,2
1Klipping C, Duijkers I, Trummer D, Marr J. Suppression of ovarian activity with a drospirenone-containing oral contraceptive in a 24/4 regimen. Contraception 2008; 78(1): 16–25
2Bayer HealthCare Pharmaceuticals, data on file (protocol number 308382)
For the full analysis set and the per-protocol set, the mean value for the maximum follicle size over all visits followed a similar pattern for both treatments with a slightly stronger suppression of follicle development in cycles 2 and 3 for YAZ® compared to the 21-day regimen (Yasminelle®).1
For YAZ®, the mean value for the maximum follicle size was 18.68 mm (SD 3.77) at pre-treatment and decreased noticeably at cycle 2 (8.32 mm, SD 2.41). For cycle 3, the 3 intentionally missed tablets at the beginning of the cycle led to an increase in the mean maximum follicle size compared to cycle 2 (cycle 3: 12.59 mm, SD 6.33). At post-treatment, values recovered and were comparable to pretreatment values (post-treatment: 20.43 mm, SD 3.74).1,2
For Yasminelle®, the mean value for the maximum follicle size was 19.87 mm (SD 4.23) at pretreatment and decreased at cycle 2 to 12.29 mm (SD 7.04). This decrease of mean maximum follicle size at cycle 2 was less pronounced compared to the 24-day regimen. For cycle 3, the 3 intentionally missed tablets at the beginning of the cycle led to an increase in the mean value for the maximum follicle size compared to cycle 2 (cycle 3: 16.90 mm, SD 7.90). At post-treatment, values recovered and were comparable to pretreatment values.1,2
1Klipping C, Duijkers I, Trummer D, Marr J. Suppression of ovarian activity with a drospirenone-containing oral contraceptive in a 24/4 regimen. Contraception 2008; 78(1): 16–25
2Bayer HealthCare Pharmaceuticals, data on file (protocol number 308382)
For the full analysis set and the per-protocol set, the mean value for the maximum follicle size over all visits followed a similar pattern for both treatments with a slightly stronger suppression of follicle development in cycles 2 and 3 for YAZ® compared to the 21-day regimen (Yasminelle®).1
For YAZ®, the mean value for the maximum follicle size was 18.68 mm (SD 3.77) at pre-treatment and decreased noticeably at cycle 2 (8.32 mm, SD 2.41). For cycle 3, the 3 intentionally missed tablets at the beginning of the cycle led to an increase in the mean maximum follicle size compared to cycle 2 (cycle 3: 12.59 mm, SD 6.33). At post-treatment, values recovered and were comparable to pretreatment values (post-treatment: 20.43 mm, SD 3.74).1,2
For Yasminelle®, the mean value for the maximum follicle size was 19.87 mm (SD 4.23) at pretreatment and decreased at cycle 2 to 12.29 mm (SD 7.04). This decrease of mean maximum follicle size at cycle 2 was less pronounced compared to the 24-day regimen. For cycle 3, the 3 intentionally missed tablets at the beginning of the cycle led to an increase in the mean value for the maximum follicle size compared to cycle 2 (cycle 3: 16.90 mm, SD 7.90). At post-treatment, values recovered and were comparable to pretreatment values.1,2
1Klipping C, Duijkers I, Trummer D, Marr J. Suppression of ovarian activity with a drospirenone-containing oral contraceptive in a 24/4 regimen. Contraception 2008; 78(1): 16–25
2Bayer HealthCare Pharmaceuticals, data on file (protocol number 308382)
18
The contraceptive effectiveness of YAZ® is also being assessed under real-life conditions in a sub-analysis of the ongoing INAS-OC study, a multinational, prospective, controlled, active surveillance, noninterventional cohort study.1
1Dinger JC, Bardenheuer K, and Assmann A. International Active Surveillance Study of Women Taking Oral Contraceptives (INAS-OC Study). BMC Med Res Methodol 2009; 9: 77
The study was started in the USA in August 2005 and was extended to six European countries in late 2008.1
Over 85,000 women will be followed up for a period up to 5 years, generating more than 220,000 WY of observation.1
1Dinger JC, Bardenheuer K, and Assmann A. International Active Surveillance Study of Women Taking Oral Contraceptives (INAS-OC Study). BMC Med Res Methodol 2009; 9: 77
Although the study was primarily designed to compare the risks of the short- and long-term use of YAZ® and other established OC formulations, the contraceptive effectiveness of OCs was also analyzed as a secondary end-point.1
1Dinger JC, Bardenheuer K, and Assmann A. International Active Surveillance Study of Women Taking Oral Contraceptives (INAS-OC Study). BMC Med Res Methodol 2009; 9: 77
To estimate real-life effectiveness, interim data from 52,218 US participants in the ongoing INAS-OC study with 1,634 unintended pregnancies during 73,269 WY of OC use were analyzed regarding contraceptive failure.1
The YAZ® cohort showed the lowest contraceptive failure rate.1
The lower rate of contraceptive failure was even more pronounced in adolescents; the Pearl Index for adolescents using 24/4 regimens was 2.5 (95% CI 2.1–2.9), compared with 5.1 (95% CI 3.7– 6.8) in adolescents using 21/7 regimens.2 In users of 21/7 regimens, the Pearl Index was 75% higher in adolescents than in adults, while in users of 24/4 regimens, the Pearl Index was 34% higher in adolescents than in adults. In terms of contraceptive failure, the adjusted hazard ratio for EE/drospirenone in a 24/4 regimen, e.g. YAZ®, versus all 21/7 regimens containing EE 20 μg in adolescents was 0.4 (95% CI 0.3–0.5).2
1Dinger J, Minh TD, Buttmann N, et al. Effectiveness of oral contraceptive pills in a large U.S. cohort comparing progestogen and regimen. Obstet Gynecol 2011; 117(1): 3340
2Dinger J. Comparative effectiveness of combined oral contraceptives in adolescents. J Fam Plann Reprod Health Care 2011; 37(2): 118
Cox regression analysis yielded an adjusted (adjusted for age, body mass index, parity, smoking, and education) hazard ratio of 0.7 (95% CI 0.6–0.8) for EE 20 µg/drospirenone 3 mg in a 24/4 regimen e.g. YAZ® versus 21/7 regimens of other progestins.1
In addition, a direct comparison of EE 20 µg/drospirenone 3 mg in a 24/4 regimen, e.g. YAZ®, with EE 30 µg/drospirenone 3 mg in a 21/7 regimen, e.g. Yasmin®, showed a statistically lower hazard ratio of 0.8 for the 24/4 regimen.1
These results indicate that EE 20 µg/drospirenone 3 mg in a 24/4 regimen, e.g. YAZ®, has higher contraceptive effectiveness during routine usage compared with EE 30 µg/drospirenone 3 mg in a 21/7 regimen, e.g. Yasmin®, and other OCs containing progestins other than drospirenone.1
INAS-OC, a large post-approval study under real-life conditions, shows that YAZ® has high contraceptive effectiveness.1
1Dinger J, Minh TD, Buttmann N, et al. Effectiveness of oral contraceptive pills in a large U.S. cohort comparing progestogen and regimen. Obstet Gynecol 2011; 117(1): 3340