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Participants had at least one reimbursement for high dose cyproterone acetate and no history of meningioma or benign brain tumour, or long term disease status. Participants were considered to be exposed when they had received a cumulative dose of at least 3 g during the first six months (139\u2009222 participants) and very slightly exposed (control group) when they had received a cumulative dose of less than 3 g (114\u2009555 participants). 10\u2009876 transgender participants (male to female) were included in an additional analysis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Main outcome measure<\/jats:title>\n            <jats:p>Surgery (resection or decompression) or radiotherapy for one or more intracranial meningiomas.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Overall, 69 meningiomas in the exposed group (during 289\u2009544 person years of follow-up) and 20 meningiomas in the control group (during 439\u2009949 person years of follow-up) were treated by surgery or radiotherapy. The incidence of meningioma in the two groups was 23.8 and 4.5 per 100\u2009000 person years, respectively (crude relative risk 5.2, 95% confidence interval 3.2 to 8.6; adjusted hazard ratio 6.6, 95% confidence interval 4.0 to 11.1). The adjusted hazard ratio for a cumulative dose of cyproterone acetate of more than 60 g was 21.7 (10.8 to 43.5). After discontinuation of cyproterone acetate for one year, the risk of meningioma in the exposed group was 1.8-fold higher (1.0 to 3.2) than in the control group. In a complementary analysis, 463 women with meningioma were observed among 123\u2009997 already using cyproterone acetate in 2006 (risk of 383 per 100\u2009000 person years in the group with the highest exposure in terms of cumulative dose). Meningiomas located in the anterior skull base and middle skull base, particularly the medial third of the middle skull base, involving the spheno-orbital region, appeared to be specific to cyproterone acetate. An additional analysis of transgender participants showed a high risk of meningioma (three per 14\u2009460 person years; 20.7 per 100\u2009000 person years).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>A strong dose-effect relation was observed between use of cyproterone acetate and risk of intracranial meningiomas. A noticeable reduction in risk was observed after discontinuation of treatment.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1136\/bmj.n37","type":"journal-article","created":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T01:01:55Z","timestamp":1612400515000},"page":"n37","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":132,"title":["Use of high dose cyproterone acetate and risk of intracranial meningioma in women: cohort study"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8687-9092","authenticated-orcid":false,"given":"Alain","family":"Weill","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moujahed","family":"Labidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Cadier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thibault","family":"Passeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise","family":"Duranteau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Laure","family":"Bernat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Yoldjian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvie","family":"Fontanel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Froelich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7674-7192","authenticated-orcid":false,"given":"Jo\u00ebl","family":"Coste","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,2,3]]},"reference":[{"key":"2021020321000477000_372.feb03_10.n37.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc071938"},{"key":"2021020321000477000_372.feb03_10.n37.2","unstructured":"Froelich S, Dali-Youcef N, Boyer P, et al. 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