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Effect of a gonadotropin‐releasing hormone analog for ovarian function preservation after intravenous cyclophosphamide therapy in systemic lupus erythematosus patients: a retrospective inception cohort study
Author(s) -
Koga Tomohiro,
Umeda Masataka,
Endo Yushiro,
Ishida Midori,
Fujita Yuya,
Tsuji Sosuke,
Takatani Ayuko,
Shimizu Toshimasa,
Sumiyoshi Remi,
Igawa Takashi,
Fukui Shoichi,
Nishino Ayako,
Kawashiri Shinya,
Iwamoto Naoki,
Ichinose Kunihiro,
Tamai Mami,
Nakamura Hideki,
Origuchi Tomoki,
Murakami Naoko,
Kitajima Michio,
Kawakami Atsushi
Publication year - 2018
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.13318
Subject(s) - medicine , hazard ratio , premature ovarian failure , cyclophosphamide , proportional hazards model , retrospective cohort study , rheumatology , hormone therapy , gastroenterology , chemotherapy , confidence interval , breast cancer , cancer
Objective To determine the effect of leuprolide acetate, a synthetic gonadotropin‐releasing hormone analog (Gn RH ‐a) on ovarian function preservation in systemic lupus erythematosus ( SLE ) patients treated with cyclophosphamide ( CYC ) in clinical practice. Methods We enrolled 30 premenopausal female SLE patients who fulfilled the 1997 American College of Rheumatology revised criteria and were treated with intravenous CYC ( IVCY ) in 2008–2017. We used Kaplan–Meier survival estimates to compare the Gn RH ‐a‐treated patients and those not treated with Gn RH ‐a as controls. We performed Cox regression analyses to identify factors associated with premature ovarian failure ( POF ), incidences of cardiovascular events, strokes and osteoporosis after IVCY therapy. Results After a mean follow‐up of 41 months, POF developed in one of the 16 Gn RH ‐a‐treated patients (6%) versus seven of the 14 controls (50%). Significantly improved cumulative ovarian protection over time was observed in the Gn RH ‐a‐treated group ( P = 0.030). The hazard model analysis showed that treatment with Gn RH ‐a during IVCY therapy is an independent factor associated with POF after IVCY therapy (adjusted hazards ratio = 0.12, 95% CI 0.01–0.67, P = 0.013) but not incidences of cardiovascular events, strokes or osteoporosis. Conclusion The combined use of Gn RH ‐a with IVCY therapy was associated with a significant reduction of POF among premenopausal women with SLE , suggesting that the addition of Gn RH ‐a can be a strategy to prevent POF among premenopausal women with SLE after IVCY therapy.