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항안드로겐 시프로테론, 덴마크 등록 자료에서 수막종 위험 7~19배와 연관, 지금은 트랜스 여성이 신규 사용자의 대부분

시프로테론 아세테이트와 수막종 위험: 전국 코호트 연구

코호트 및 등록 연구교차성호르몬
Authors
Anders Pretzmann Mikkelsen, Iben Katinka Greiber, Nikolai Madrid Scheller, Malene Hilden, Øjvind Lidegaard
Journal
Journal of Neurology, Neurosurgery & Psychiatry
Year
2022
Source
https://doi.org/10.1136/jnnp-2021-326138

Summary

Cyproterone acetate (CPA) is a drug that blocks testosterone. Outside the US it is widely used in hormone treatment for trans women. Danish researchers used national health records covering nearly everyone in the country to compare rates of meningioma, a usually non-cancerous brain tumour, in CPA users and non-users. Users had about 7 times the risk at lower total doses and 19 times at higher doses, and risk stayed raised after stopping. Most users over the whole period were not trans, but by 2019 two-thirds of new users were, so the finding matters directly for trans women. The fact that risk rose with dose, and that a large French study found the same, makes the link believable. But it rests on only 16 cases and cannot give a risk figure for trans people specifically.

Key findings

  • 연구는 약 570만 명의 덴마크인을 다루었으며 그중 1,982명이 사이프로테론 아세테이트(CPA)를 복용했습니다.
  • 수막종(보통 암이 아닌 뇌종양) 8,957건 중 16건이 CPA를 복용한 사람에게서 발생했습니다.
  • 총용량이 0.1~10그램인 사람은 비사용자의 약 7배, 10그램을 넘는 사람은 약 19배의 위험이 있었습니다.
  • CPA를 중단한 과거 사용자도 한 번도 복용하지 않은 사람의 약 5배 위험이 있었습니다.
  • 신규 CPA 사용자는 2013년에서 2019년 사이 100만 명당 18명에서 62명으로 늘었고, 그중 트랜스인 비율은 18%에서 68%로 늘었습니다.
  • 참고로 트랜스 여성의 통상 용량인 하루 50mg은 7개월 안에 10그램에 도달합니다.
  • 결과는 위험이 용량에 따라 가파르게 올랐음을 마찬가지로 밝힌 프랑스의 대규모 연구(Weill 등, 2021)와 일치합니다.

Abstract

[No abstract in the published research letter; this is the abstract of the medRxiv preprint, doi 10.1101/2020.12.29.20248395] Cyproterone acetate (CPA) is a synthetic steroid hormone. We assessed the association between the use of CPA and the risk of developing meningioma. In a historical prospective cohort study, using Danish national healthcare registers we included a cohort of 5,730,654 individuals, among whom 1,982 were exposed to CPA. During follow-up, we identified 8,957 cases of meningioma, of which 16 were exposed to CPA. From 2013 to 2019 the number of new users increased from 18.1 to 62.3 new users per million, while the proportion of new users who were transgender increased from 18.4 to 68.3%. Analyses showed a significantly increased risk of meningioma according to cumulative dose of CPA; 0.1-10 grams of CPA, incidence rate 78.8 (95% CI 15.7-141.9) per 100.000 person years and adjusted hazard ratio 7.0 (3.1-15.6); >10 grams of CPA, incidence 187.5 (71.3-303.7) and adjusted hazard ratio 19.2 (10.3-35.8), as compared to the background population. In conclusion, the cumulative dose of CPA was associated with an increased incidence and hazard ratio of meningioma, showing a dose-response relationship. The number of new CPA users increased more than 3-fold from 2013 to 2019, primarily driven by new transgender users.

Conclusion

The cumulative dose of CPA was associated with an increased incidence and hazard ratio of meningioma, showing a dose-response relationship. The number of new CPA users increased more than threefold from 2013 to 2019, primarily driven by new transgender users. The authors note that the association has now been reproduced in two large cohort studies (with the French Weill et al. BMJ 2021 study), with a clear dose-response effect and large measures of association.