Ovarian function is preserved in women with severe systemic lupus erythematosus after a 6-month course of cyclophosphamide followed by mycophenolate mofetil

• Published in: Clinical and experimental rheumatology 2010, Vol.28 (1), p.83-86
• Main Authors: LASKARI, K, ZINTZARAS, E, TZIOUFAS, A. G
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Amenorrhea - chemically induced; Amenorrhea - epidemiology; Amenorrhea - prevention & control; Biological and medical sciences; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Diseases of the osteoarticular system; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - epidemiology; Medical sciences; Middle Aged; Mycophenolic Acid - administration & dosage; Mycophenolic Acid - adverse effects; Mycophenolic Acid - analogs & derivatives; Non tumoral diseases; Ovarian Function Tests; Ovary - drug effects; Ovary - physiology; Premenopause; Pulse Therapy, Drug; Retrospective Studies; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Severity of Illness Index; Young Adult
• ISSN: 0392-856X; 1593-098X

To evaluate whether a short duration treatment with cyclophosphamide (CYC) followed by mycophenolate mofetil (MMF) is associated with preservation of the ovarian function in female patients with systemic lupus erythematosus (SLE). We retrospectively evaluated 61 premenopausal women with SLE treated for lupus nephritis (n=58), autoimmune hemolytic anemia (n=1) and central nervous system involvement (n=2). Thirty-nine patients received prolonged treatment with 1 g/m2 intravenous (IV) CYC pulses (group I). 22 patients received 5-7 monthly 1 g/m2 IV CYC pulses and afterwards 2 g/day MMF (group II). Disease activity was equally controlled using either regimen (p=0.76 and p=0.31 for disease remission and relapse respectively). Amenorrhea developed in 56% of women in group I (n=22) and 14% in group II (n=3) (p=0.01), whereas sustained amenorrhea developed in 51% (n=20) of women in group I versus 4% (n=1) in group II (p=0.05). Most women with amenorrhea in group I (86%) did not resume menses after the cessation of therapy versus one woman (33%) in group II. In logistic regression, group I had a 4-fold higher risk of amenorrhea and 5-fold higher risk of sustained amenorrhea compared to group II (p=0.001 and p=0.009 respectively). Age (p