Comparative safety and effectiveness of TCu380A versus MLCu375: a systematic review of randomized trials

Abstract

To compare the relative effectiveness and side effects of two intrauterine devices (IUDs), TCu380A and Multiload Cu375 (MLCu375). We searched PubMed, EMBASE, the Cochrane Library, POPLINE, SCOPUS, and the Chinese Biomedical Literature Database in all languages, along with reference lists of retrieved papers. Randomized controlled trials comparing TCu380A with MLCu375 were included. The outcomes examined were pregnancy, continuation, removal, expulsion, infection, pain, abnormal menstruation, uterine perforation, and other adverse events. Two reviewers independently extracted the data. Data from the trials were combined to calculate relative risks (RRs) along with 95% confidence intervals (CIs). Sixteen trials were included, involving 15236 participants. Generally the methodological quality was poor. Compared to MLCu375, TCu380A was associated with less pregnancy and expulsion at five years with (RR: 0.49, 95% CI: 0.33 to 0.72; RR: 0.63, 95% CI: 0.45 to 0.89; respectively), as well as more removals for bleeding and/or pain at three years and pelvic infection disease over the whole study period (RR: 1.83, 95% CI: 1.28 to 2.62; RR: 1.47, 95% CI: 1.03 to 2.11; respectively). There were no statistical differences at all time intervals to 5 years in continuation rates or rates of uterine perforation. While there was some variability between study results, we found evidence that TCu380A is more effective than MLCu375, with a similar side-effect profile.