NuvaRing announces free voucher program
Will women in your care be interested in using the contraceptive vaginal ring (NuvaRing, Organon, West Orange, NJ) when it becomes available in summer 2002? Their interest may be piqued by the manufacturer’s recent announcement to issue vouchers for one free ring per patient.
How long will the voucher program be in effect? At this point, there is no cut off date, says Amanda Mason, Organon spokeswoman.
"Organon intends to continue with this program as long as women are taking advantage of it," states Mason. "There is no limit to the number of women who can receive a free NuvaRing, but each woman is limited to one free trial within the one-year expiration date on the voucher."
The contraceptive vaginal ring is expected to hit U.S. drugstore shelves this summer. It received Food and Drug Administration approval in October 2001. Cost for the device is expected to be comparable to monthly supplies of combined oral contraceptives. (Contraceptive Technology Update reported on the approval; see "Organon launches Nuva-Ring, first combined contraceptive vaginal ring," December 2001, p. 137.)
When the product is launched, women can sign up for the vouchers at its web site, www.nuvaring.com. Providers also will be given voucher forms to give out with NuvaRing prescriptions; Organon sales representatives will distribute the forms with product starter kits, says Mason.
While vaginal rings have been used for hormone replacement therapy, NuvaRing represents the first contraceptive vaginal ring. The device is a small, flexible, transparent ring; it works by releasing a continuous low dose of estrogen and progestin (an average 0.120 mg of etonogestrel and 0.015 mg of ethinyl estradiol) per day over a 21-day period of use. It is inserted in the vagina, where it remains for three weeks, and then is removed for one week. (Get in-depth information on the NuvaRing; read the Contraceptive Technology Reports "The Vaginal Contraceptive Ring — Efficacy, Caution, and Instructions" inserted in the February 2002 issue of CTU.)
In a one-year, multicenter study assessing the contraceptive efficacy, cycle control, tolerability, and acceptability of the contraceptive, 1,145 women were exposed to the vaginal ring for 12,109 cycles (928 woman-years). Six pregnancies occurred during treatment, giving a Pearl Index of 0.65 (95% confidence interval 0.24 — 1.41)1 Cycle control was very good, because irregular bleeding was rare, reported investigators.
The exact positioning of NuvaRing within the vagina is not critical for it to work; because the device is not a barrier contraceptive, it cannot be incorrectly inserted within the vagina. Women can insert the device lying down, squatting, or standing with one leg up.
When counseling women on NuvaRing use, remember to inform them that device use does not prevent HIV infection or sexually transmitted diseases.
Check provider program
Some providers are getting a head start on introducing the NuvaRing through a "premier program" instituted by Organon. Some 6,500 physicians and nurse practitioners signed up for the program; each could enroll up to five patients, offering six months’ free supplies of rings. Enrollment in the program is now closed.
According to the company, preliminary findings indicate that 89% of patients enrolled in the program were satisfied with NuvaRing compared to their former method of contraception, and 94% are likely to continue using the device. Additional information from the program will be reported later this year.
The convenience of the device is a major advantage for patients seen by Raquel Arias, MD, associate professor of clinical obstetrics and gynecology and associate dean for women in the Keck School of Medicine at the University of Southern California in Los Angeles. Arias, who also served as an investigator in the U.S. trial of the NuvaRing, says the "one-size-fits-all" device makes it easy for women to insert the NuvaRing. Since placement is not key to its efficacy, it makes instruction for use that much easier, she notes.
Arias says her patients report no problems in wearing the device, and they say their partners cannot tell when the device is in place. She has recorded no patient problems with breakthrough bleeding or spotting.
"It is a good method for people who want to have effective contraception that is more convenient than a daily method, and is just as effective, if not more effective," observes Arias. "If efficacy and convenience are important, then I think this is a great option for women who would otherwise be good candidates for birth control pills."
Reference
1. Roumen FJ, Apter D, Mulders TM, et al. Efficacy, tolerability, and acceptability of a novel contraceptive vaginal ring releasing etonogestrel and ethinyl oestradiol. Hum Reprod 2001; 16:469-475.
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