Abstract
BackgroundThe risk for amenorrhea following treatment of systemic lupus erythematosus (SLE) patients with low-dose intravenous cyclophosphamide (IVCY) has not been fully explored. Our objective was to ascertain the incidence of amenorrhea following treatment with low-dose IVCY and the association between amenorrhea and the clinical parameters of SLE.MethodsA case-control retrospective study of premenopausal women ≤ 45 years old who had been treated for SLE with low-dose IVCY (500 mg/body/pulse) plus high-dose glucocorticoids (0.8-1.0 mg/kg/day of prednisolone; IVCY group) or glucocorticoids alone (0.8-1.0 mg/kg/day of prednisolone; steroid group) in our hospital from 2000 through 2009 was conducted using a questionnaire survey and medical record review.ResultsTwenty-nine subjects in the IVCY group and 33 subjects in the steroid group returned the questionnaire. A multivariate analysis revealed that age at initiation of treatment ≥ 40 years old was significantly associated with amenorrhea [p = 0.009; odds ratio (OR) 10.2; 95% confidence interval (CI) 1.8-58.7]. IVCY treatment may display a trend for association with amenorrhea (p = 0.07; OR 2.9; 95% CI 0.9-9.4). Sustained amenorrhea developed in 4 subjects in the IVCY group and 1 subject in the steroid group; all of these patients were ≥ 40 years old. Menses resumed in all subjects < 40 years old, irrespective of treatment.ConclusionsAlthough low-dose IVCY may increase the risk for amenorrhea, our data suggest that patients < 40 years old have a minimum risk for sustained amenorrhea with low-dose IVCY treatment. A higher risk for sustained amenorrhea following treatment with IVCY is a consideration for patients ≥ 40 years old.
Highlights
The risk for amenorrhea following treatment of systemic lupus erythematosus (SLE) patients with low-dose intravenous cyclophosphamide (IVCY) has not been fully explored
Characteristics of the study subjects a total of 62 female subjects with SLE provided informed consent for inclusion in this study and returned the questionnaire, representing 86% of the number invited to participate; 29 subjects were treated with IVCY in combination with glucocorticoids (IVCY group), and 33 were treated with glucocorticoids alone
The important findings of this study are that i) patients < 40 years old have a minimum risk for sustained amenorrhea with low-dose IVCY treatment; ii) irrespective of treatment regimen, sustained amenorrhea developed frequently in patients ≥ 40 years old at initiation of treatment; iii) even low-dose IVCY may increase the risk of transient amenorrhea; and iv) the strongest risk factor for developing amenorrhea in SLE patients treated with high-dose glucocorticoids with or without low-dose
Summary
The risk for amenorrhea following treatment of systemic lupus erythematosus (SLE) patients with low-dose intravenous cyclophosphamide (IVCY) has not been fully explored. Our objective was to ascertain the incidence of amenorrhea following treatment with low-dose IVCY and the association between amenorrhea and the clinical parameters of SLE. Most data for understanding the biological characteristics of cyclophosphamide gonadotoxicity comes from the oncology literature, several studies have examined cyclophosphamide-induced amenorrhea in women receiving traditional IVCY regimens in SLE [5,6,7,8,9,10,11]. The incidence of major side effects did not differ significantly between the traditional and the low-dose IVCY regimen groups, perhaps because of the low number of subjects included in the original study [12]. The effects of low-dose IVCY on cyclophosphamide-induced amenorrhea have not been elucidated
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
