Randomized Study of Oral Contraceptives or Hormone Replacement Therapy in Women With Systemic Lupus Erythematosus

PROTOCOL ENTRY CRITERIA: --Disease Characteristics-- Established systemic lupus erythematosus meeting American College of Rheumatology criteria Inactive disease Systemic Lupus Erythematosus Activity Index (SLEDAI) score no greater than 4 No increase in score of more than 2 from baseline over the past 3 months Receiving the equivalent of 5 mg or less of prednisone per day OR Stable/active disease SLEDAI score 5-12 No increase in score of more than 2 from baseline over the past 3 months Prednisone dose up to 0.5 mg/kg/day for control of underlying disease allowed if stable dose for at least 3 weeks No concurrent severe disease activity as defined by any of the following: Acute renal disease (i.e., rising creatinine levels, cellular sediment, or increasing proteinuria) Involvement of 3 or more organ systems requiring more than the equivalent of 0.5 mg/kg/day of prednisone Necessity of immediate hospitalization for symptom control No presence of a high titer IgG, IgM, or IgA antiphospholipid antibodies (aPL) GPL and MPL no more than 40 APL no more than 50 No features of primary antiphospholipid antibody syndrome --Prior/Concurrent Therapy-- Biologic therapy: Not specified Chemotherapy: Not specified Endocrine therapy: See Disease Characteristics Radiotherapy: Not specified Surgery: Prior hysterectomy allowed --Patient Characteristics-- Age: 35 and under for oral contraceptive stratum (premenopausal) 50 and over for hormone replacement therapy stratum (postmenopausal) Menopausal status: Premenopausal for oral contraceptive stratum Postmenopausal for hormone replacement therapy stratum Follicle-stimulating hormone greater than 40 mIU/mL OR Amenorrhea for 6 months Performance status: See Disease Characteristics Hematopoietic: Not specified Hepatic: No hepatic dysfunction No tumors of the liver Renal: See Disease Characteristics Cardiovascular: No uncontrolled high blood pressure requiring frequent change in medication Concurrent hypertension controlled with stable medication allowed No history of spontaneous superficial or deep venous thrombosis or arterial thrombosis No prior myocardial infarction Oral contraceptive stratum: No angina No diastolic blood pressure greater than 90 mm Hg or systolic blood pressure greater than 140 mm Hg on 3 separate determinations Hormone replacement therapy stratum: No diastolic blood pressure greater than 95 mm Hg or systolic blood pressure greater than 145 mm Hg on 3 separate determinations Pulmonary: No history of pulmonary embolus Other: Not pregnant Oral contraceptive stratum: Negative pregnancy test Fertile patients must use effective barrier contraception No prior gynecologic malignancy or breast malignancy No undiagnosed vaginal bleeding No diabetes (present prior to use of glucocorticoids) requiring oral hypoglycemic medications or insulin No congenital hyperlipidemia No complicated migraines (i.e., associated with neurological sequelae)