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Year : 2019  |  Volume : 46  |  Issue : 2  |  Page : 85-91

Premature ovarian failure in systemic lupus erythematosus patients: is it related to cyclophosphamide treatment?

1 Rheumatology and Rehabitation Department, Minia University, Minia, Egypt
2 Obstetric and Gynecology Department, Minia University, Minia, Egypt

Correspondence Address:
Rasha M Ghaleb
27 Nefriti Street, Minia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/err.err_53_18

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Introduction Systemic lupus erythematosus (SLE) is a chronic autoimmune systemic disease that mainly affects women during the childbearing period. Cyclophosphamide (CYC) is the drug of choice for severe SLE manifestations. However, many side effects had been reported. Premature ovarian failure (POF) is one of the serious complications that can occur in SLE patients. Aim The aim was to evaluate the prevalence of POF in female patients with SLE and whether it is related to CYC treatment or not. Patients and methods One hundred women with SLE satisfying the updated revised criteria for the classification of SLE were studied. The patients were allocated into two groups: CYC-treated group (n=55) and non-CYC-treated group (n=45). Patients were interviewed and demographic characteristics, clinical and serologic profiles, and menstrual histories were recorded. Disease activity was measured by the SLE disease activity index. Serum anti-Müllerian hormone was measured as a marker for ovarian reserve assessment in the two study groups. Results Ovarian failure occurred in 15 (27.3%) patients out of the 55 SLE patients treated with CYC. The cumulative CYC dose was significantly higher in patients with ovarian failure than in those without this condition (11.7 vs. 9.5 g; P=0.001). The cumulative dose of CYC and the older age at initiation were found to be associated more with POF. Conclusion In our population of female SLE patients, CYC-induced ovarian failure is a significant problem occurring in 27.3% of SLE patients receiving CYC. So, for SLE patients in whom the use of CYC is mandatory, a lower dosage and a shorter course of this agent should be considered. Co-treatment with gonadotropin-releasing hormone agonists might persevere the future fertility and ovarian function in young women. Ovarian banking before administration of CYC could be a possible solution in certain cases.

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