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Ovarian failure in SLE patients using pulse cyclophosphamide: comparison of different regimes

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Abstract

The objective of this study was to determine the frequency and risk factors of early ovarian failure in systemic lupus erythematosus (SLE) women treated with cyclophosphamide (CY). We further tried to determine if there was a reduction of ovarian failure in recent years, due to reduction in the CY dose. We reviewed the charts of all women below 40 years of age who received intravenous CY pulse therapy. In order to be included, the patients must have finished CY treatment before completing 40 years. Patients were divided into two groups: Group A (57 patients), patients who were treated with 0.75 mg/body surface; Group B (50 patients), patients treated with 0.5 mg/body surface. Fifty patients with similar age distribution who never received CY were selected from the database as a control group (Group C). The Chi-square test was applied to compare the categorical variables of the groups and whenever needed, the Fisher’s Exact test was used. We observed similar age distribution and disease duration at disease onset between groups. Also, no differences regarding the age at menarche, total prednisone dose, and SLICC-ACR/DI scores were observed at disease onset between the three groups. In group A, ten (17.5%) patients refereed sustained amenorrhea, independently associated with treatment duration (P = 0.001), total intravenous cyclophosphamide (IV-CF) dose (P = 0.02), older age at disease onset (P = 0.04). Seven (12.3%) patients referred transient amenorrhea. Transient amenorrhea was related to CY treatment duration (P = 0.017). In group B, no patient reported sustained amenorrhea and 10 of 50 (20%) patients referred transient amenorrhea, related to CY treatment duration (P = 0.017). The most important risk factors for menstrual abnormalities were duration of treatment and cumulative dose of CY. Lower CY dose reduced the number of premature ovarian failures significantly in this cohort.

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Authors and Affiliations

  1. McGill University, Montreal, Canada

    Simone Appenzeller

  2. Rheumatology Unit, Department of Internal Medicine, State University of Campinas, Campinas, Brazil

    Simone Appenzeller, Paula F. Blatyta & Lilian T. L. Costallat

  3. Disciplina de Reumatologia, Departamento de Clínica Médica Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP) Distrito de Barão Geraldo, Campinas-SP, CEP 13081-970, Brazil

    Simone Appenzeller

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  1. Simone Appenzeller
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  2. Paula F. Blatyta
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  3. Lilian T. L. Costallat
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Correspondence to Simone Appenzeller.

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This study was supported by grants from National Council for Scientific and Technological Development (CNPq) and FAPESP.

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Appenzeller, S., Blatyta, P.F. & Costallat, L.T.L. Ovarian failure in SLE patients using pulse cyclophosphamide: comparison of different regimes. Rheumatol Int 28, 567–571 (2008). https://doi.org/10.1007/s00296-007-0478-3

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  • DOI: https://doi.org/10.1007/s00296-007-0478-3

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