Spironolactone use in women does not increase the risk of meningioma: A population-based cohort study

Summary: Abstract Body: Meningioma pathogenesis is linked to hormonal factors due to its higher prevalence among females during reproductive years and association with progestogen use. Spironolactone, a diuretic with progesterone receptor activity, is commonly prescribed for dermatologic conditions. Given its hormonal receptor affinity, we examined the association between spironolactone and meningioma in females. We conducted a retrospective cohort study using the TriNetX database, including female adults with spironolactone indications. Those with other hormone/antiandrogen therapy use were excluded. Propensity score matching controlled for demographic, socioeconomic, comorbidity, and healthcare utilization factors between spironolactone users and nonusers. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). Sensitivity analyses included: 1) adjusting the start of follow-up from 1 to 180 days post-spironolactone prescription to account for cancer induction period, and 2) using eplerenone, a selective mineralocorticoid receptor antagonist, as a comparator. Among 115,184 female spironolactone users (mean age, 54.2±15.5 years) and matched nonuser controls, meningioma incidences were 0.4% for both groups over a mean 5.3-year follow-up. Spironolactone use was not significantly associated with meningioma risk (HR[95% CI], 1.08[0.95–1.22]) overall, nor did it increase the risk of benign (1.09[0.95-1.24]), uncertain (1.14 [0.71-1.84]), or malignant meningiomas (1.05[0.64-1.74]). Sensitivity analyses confirmed these findings. Despite its progesterone receptor affinity, spironolactone does not elevate meningioma risk. This finding is significant when evaluating treatment options for female patients, as meningioma is the most common benign brain tumor. Aubrey Martin¹, Li Chi Chen³, Tina Yi Jin Hsieh⁴, Maryanne Senna^{1, 2} 1. Dermatology, Lahey Hospital & Medical Center, Burlington, MA, United States. 2. Dermatology, Harvard Medical School, Boston, MA, United States. 3. Dermatology, University of Massachusetts Chan Medical School, Worcester, MA, United States. 4. Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States. Clinical Research: Epidemiology and Observational Research