Brief Papers

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

K. Laskari, E. Zintzaras, A.G. Tzioufas

CER518
2010 Vol.28, N°1
PI 0083, PF 0086
Brief Papers

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PMID: 20346244 [PubMed]

Received: 16/07/2009
Accepted : 12/10/2009
In Press: 11/03/2010
Published: 15/03/2010

Abstract

OBJECTIVES:
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).
METHODS:
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).
RESULTS:
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<0.001), cumulative CYC dose (p=0.001) and anti-Ro antibodies (p=0.002) were significant in terms of amenorrhea, while sustained amenorrhea was significantly associated with the patient age (p=0.026).
CONCLUSIONS:
We suggest that treatment with MMF following 5-7 IV pulses of CYC is an effective mean to control disease activity and preserve ovarian function in premenopausal women with SLE.