 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 September 1993 | Volume 119 Issue 5 | Pages 366-369
Objective: To determine the risk for secondary amenorrhea after pulse cyclophosphamide therapy in premenopausal women with systemic lupus erythematosus.
Design: Controlled, retrospective clinical study.
Setting: Government referral-based research hospital.
Patients: Thirty-nine women younger than 40 years treated with pulse cyclophosphamide therapy for active lupus nephritis or neuropsychiatric lupus. Sixteen women who received pulses of intravenous methylprednisolone were controls.
Interventions: Sixteen patients received pulse cyclophosphamide (0.5 to 1.0 g/m2 body surface area) monthly for a total of 7 doses (short-CY), and 23 patients received 15 or more doses (long-CY). Control patients were treated with monthly pulses of methylprednisolone (1.0 g/m2) for a total of nine doses.
Measurements: Rates of amenorrhea were evaluated according to duration of treatment (number of doses) and age at the initiation of pulse therapy.
Results: Two of 16 patients (12%) in the Short-CY group and 9 of 23 (39%) in the long-CY group developed sustained amenorrhea (P = 0.07). Rates of sustained amenorrhea (short- and long-CY) according to age at the start of pulse therapy were:
Conclusions: Intermittent pulse cyclophosphamide therapy in patients with systemic lupus erythematosus is associated with sustained amenorrhea, which is related to both age and number of doses of cyclophosphamide.
Author and Article Information
From the National Institute of Diabetes and Digestive and Kidney Diseases; the Nursing Department, Clinical Center; the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland.
ARTICLE
Risk for Sustained Amenorrhea in Patients with Systemic Lupus Erythematosus Receiving Intermittent Pulse Cyclophosphamide Therapy
25 years, 2/16 (12%); 26 to 30 years, 4/15 (27%); 
31 years, 5/8 (62%) (P = 0.04). The increased risk for sustained amenorrhea in patients treated with long-CY was most evident in patients older than 25 years (short-CY [2/12] compared with long-CY [7/11]; P = 0.03). Three other patients with short-CY had reversal of amenorrhea fewer than 12 months after cessation of therapy. Amenorrhea was not observed in any of the 16 control patients.
Request for Reprints: Dimitrios T. Boumpas, MD, National Institutes of Health (NIH), Building 10, Room 3N-112, Bethesda, MD 20892.
Acknowledgments: The authors thank Lisa A. Miller for her help during the preparation of the manuscript.
This article has been cited by other articles:
|
|
 |
|
  M. Costa and D. Colia Treating infertility in autoimmune patients Rheumatology, June 1, 2008; 47(suppl_3): iii38 - iii41. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Gayed and C. Gordon Pregnancy and rheumatic diseases Rheumatology, November 1, 2007; 46(11): 1634 - 1640. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Walsh, M. James, D. Jayne, M. Tonelli, B. J. Manns, and B. R. Hemmelgarn Mycophenolate Mofetil for Induction Therapy of Lupus Nephritis: A Systematic Review and Meta-Analysis Clin. J. Am. Soc. Nephrol., September 1, 2007; 2(5): 968 - 975. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.A.A. Silva and H.I. Brunner Review: Gonadal functioning and preservation of reproductive fitness with juvenile systemic lupus erythematosus Lupus, August 1, 2007; 16(8): 593 - 599. [Abstract] [PDF]
|
|
|
|
|
|
A. Tincani, M. Nuzzo, A. Lojacono, M. Cattalini, and A. Meini Review: Contraception in adolescents with systemic lupus erythematosus Lupus, August 1, 2007; 16(8): 600 - 605. [Abstract] [PDF]
|
|
|
|
|
|
C.A.A. Silva, M.O. Hilario, M.V. Febronio, S.K. Oliveira, M.T. Terreri, S.B. Sacchetti, F.R. Sztajnbok, R. Marini, M.V. Quintero, B.E. Bica, et al. Risk factors for amenorrhea in juvenile systemic lupus erythematosus (JSLE): a Brazilian multicentre cohort study Lupus, July 1, 2007; 16(7): 531 - 536. [Abstract] [PDF]
|
|
|
|
|
|
G. G. Illei, C. H. Yarboro, T. Kuroiwa, R. Schlimgen, H. A. Austin, J. F. Tisdale, P. Chitkara, T. Fleisher, J. H. Klippel, J. E. Balow, et al. Long-term effects of combination treatment with fludarabine and low-dose pulse cyclophosphamide in patients with lupus nephritis Rheumatology, June 1, 2007; 46(6): 952 - 956. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Moroni, B. Gallelli, S. Quaglini, G. Banfi, E. Rivolta, P. Messa, and C. Ponticelli Withdrawal of therapy in patients with proliferative lupus nephritis: long-term follow-up Nephrol. Dial. Transplant., June 1, 2006; 21(6): 1541 - 1548. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H I Brunner, A Bishnoi, A C Barron, L J Houk, A Ware, Y Farhey, A B Mongey, C F Strife, T B Graham, and M H Passo Disease outcomes and ovarian function of childhood-onset systemic lupus erythematosus Lupus, April 1, 2006; 15(4): 198 - 206. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Petri and R. Brodsky High-Dose Cyclophosphamide and Stem Cell Transplantation for Refractory Systemic Lupus Erythematosus JAMA, February 1, 2006; 295(5): 559 - 560. [Full Text] [PDF]
|
|
|
|
|
|
N. C. T. Kong Pregnancy of a lupus patient--a challenge to the nephrologist Nephrol. Dial. Transplant., February 1, 2006; 21(2): 268 - 272. [Full Text] [PDF]
|
|
|
|
|
|
A. Rahman, S. J. Bowman, I. P. Giles, Y. Ioannou, and D. A. Isenberg Annus mirabilis--a guide to the 6th European Lupus Meeting, 3-5 March 2005 Rheumatology, August 1, 2005; 44(8): 962 - 964. [Full Text] [PDF]
|
|
|
|
 |
|
 G H Stummvoll, M Aringer, J S Smolen, S Schmaldienst, E Jimenez-Boj, W H Horl, W B Graninger, and K Derfler IgG immunoadsorption reduces systemic lupus erythematosus activity and proteinuria: a long term observational study Ann Rheum Dis, July 1, 2005; 64(7): 1015 - 1021. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Fine Pharmacological Therapy of Lupus Nephritis JAMA, June 22, 2005; 293(24): 3053 - 3060. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G Contreras, E Tozman, N. Nahar, and D. Metz Maintenance therapies for proliferative lupus nephritis: mycophenolate mofetil, azathioprine and intravenous cyclophosphamide Lupus, March 1, 2005; 14(3_suppl): s33 - s38. [Abstract] [PDF]
|
|
|
|
|
|
C. Gorman, A. Bhatia, and A. Rahman This house believes that low-dose intravenous cyclophosphamide is superior to standard high-dose regimes for treatment of lupus nephritis Rheumatology, March 1, 2005; 44(3): 398 - 401. [Full Text] [PDF]
|
|
|
|
|
|
F A Houssiau Cyclophosphamide in lupus nephritis Lupus, January 1, 2005; 14(1): 53 - 58. [Abstract] [PDF]
|
|
|
|
|
|
F Perfumo and A Martini Lupus nephritis in children Lupus, January 1, 2005; 14(1): 83 - 88. [Abstract] [PDF]
|
|
|
|
|
|
A. Raptopoulou, P. Sidiropoulos, and D. T Boumpas Ovarian failure and strategies for fertility preservation in patients with systemic lupus erythematosus Lupus, December 1, 2004; 13(12): 887 - 890. [PDF]
|
|
|
|
 |
|
 F. A. Houssiau Management of Lupus Nephritis: An Update J. Am. Soc. Nephrol., October 1, 2004; 15(10): 2694 - 2704. [Full Text] [PDF]
|
|
|
|
|
|
G E Katsifis and A G Tzioufas Ovarian failure in systemic lupus erythematosus patients treated with pulsed intravenous cyclophosphamide Lupus, September 1, 2004; 13(9): 673 - 678. [Abstract] [PDF]
|
|
|
|
|
|
M-C Park, Y-B Park, S Y Jung, I H Chung, K H Choi, and S-K Lee Risk of ovarian failure and pregnancy outcome in patients with lupus nephritis treated with intravenous cyclophosphamide pulse therapy Lupus, August 1, 2004; 13(8): 569 - 574. [Abstract] [PDF]
|
|
|
|
|
|
D Jayne and A Tyndall Autologous stem cell transplantation for systemic lupus erythematosus Lupus, May 1, 2004; 13(5): 359 - 365. [Abstract] [PDF]
|
|
|
|
|
|
M Petri Cyclophosphamide: new approaches for systemic lupus erythematosus Lupus, May 1, 2004; 13(5): 366 - 371. [Abstract] [PDF]
|
|
|
|
|
|
P I Sidiropoulos and D T Boumpas Lessons learned from anti-CD40L treatment in systemic lupus erythematosus patients Lupus, May 1, 2004; 13(5): 391 - 397. [Abstract] [PDF]
|
|
|
|
|
|
P. Riley, S. M. Maillard, L. R. Wedderburn, P. Woo, K. J. Murray, and C. A. Pilkington Intravenous cyclophosphamide pulse therapy in juvenile dermatomyositis. A review of efficacy and safety Rheumatology, April 1, 2004; 43(4): 491 - 496. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Contreras, V. Pardo, B. Leclercq, O. Lenz, E. Tozman, P. O'Nan, and D. Roth Sequential Therapies for Proliferative Lupus Nephritis N. Engl. J. Med., March 4, 2004; 350(10): 971 - 980. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Jayne, J. Passweg, A. Marmont, D. Farge, X. Zhao, R. Arnold, F. Hiepe, I. Lisukov, M. Musso, J. Ou-Yang, et al. Autologous stem cell transplantation for systemic lupus erythematosus Lupus, March 1, 2004; 13(3): 168 - 176. [Abstract] [PDF]
|
|
|
|
|
|
M El Hachmi, M Jadoul, C Lefebvre, G Depresseux, and F A Houssiau Relapses of lupus nephritis: incidence, risk factors, serology and impact on outcome Lupus, September 1, 2003; 12(9): 692 - 696. [Abstract] [PDF]
|
|
|
|
|
|
C C Mok and C S Lau Lupus in Hong Kong Chinese Lupus, September 1, 2003; 12(9): 717 - 722. [Abstract] [PDF]
|
|
|
|
|
|
C P Mavragani and H M Moutsopoulos Lupus nephritis: current issues Ann Rheum Dis, September 1, 2003; 62(9): 795 - 798. [Full Text] [PDF]
|
|
|
|
|
|
C C Mok, R W S Wong, and K N Lai Treatment of severe proliferative lupus nephritis: the current state Ann Rheum Dis, September 1, 2003; 62(9): 799 - 804. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Sanni and M. A Khamashta Low-dose pulse cyclophosphamide in the treatment of neuropsychiatric lupus Lupus, January 1, 2003; 12(1): 1 - 2. [PDF]
|
|
|
|
|
|
L Stojanovich, R Stojanovich, V Kostich, and E Dzjolich Neuropsychiatric lupus favourable response to low dose i.v. cyclophosphamide and prednisolone (pilot study) Lupus, January 1, 2003; 12(1): 3 - 7. [Abstract] [PDF]
|
|
|
|
|
|
C A A Silva, M M Leal, C Leone, V P Simone, A D Takiuti, M I Saito, and M H B Kiss Gonadal function in adolescents and young women with juvenile systemic lupus erythematosus Lupus, July 1, 2002; 11(7): 419 - 425. [Abstract] [PDF]
|
|
|
|
|
|
G. E. Katsifis, A. G. Tzioufas, P. G. Vlachoyiannopoulos, M. Voulgarelis, H. M. Moutsopoulos, and J. P. A. Ioannidis Risk of myelotoxicity with intravenous cyclophosphamide in patients with systemic lupus erythematosus Rheumatology, July 1, 2002; 41(7): 780 - 786. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. A. Houssiau and M. Jadoul Cytotoxic therapy of lupus nephritis: recent developments Nephrol. Dial. Transplant., June 1, 2002; 17(6): 955 - 957. [Full Text] [PDF]
|
|
|
|
 |
|
 H L Weiner and J A Cohen Treatment of multiple sclerosis with cyclophosphamide: critical review of clinical and immunologic effects Multiple Sclerosis, April 1, 2002; 8(2): 142 - 154. [Abstract] [PDF]
|
|
|
|
|
|
S G Pasoto, B B Mendonca, and E Bonfa Menstrual disturbances in patients with systemic lupus erythematosus without alkylating therapy: clinical, hormonal and therapeutic associations Lupus, March 1, 2002; 11(3): 175 - 180. [Abstract] [PDF]
|
|
|
|
 |
|
 G. G. Illei, H. A. Austin III, M. Crane, L. Collins, M. F. Gourley, C. H. Yarboro, E. M. Vaughan, T. Kuroiwa, C. L. Danning, A. D. Steinberg, et al. Combination Therapy with Pulse Cyclophosphamide plus Pulse Methylprednisolone Improves Long-Term Renal Outcome without Adding Toxicity in Patients with Lupus Nephritis Ann Intern Med, August 21, 2001; 135(4): 248 - 257. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Adu The evidence base for the treatment of lupus nephritis in the new millennium Nephrol. Dial. Transplant., August 1, 2001; 16(8): 1536 - 1538. [Full Text] [PDF]
|
|
|
|
|
|
D L. T. Huong, B Wechsler, D Vauthier-Brouzes, H Beaufils, G Lefebvre, and J-C Piette Pregnancy in past or present lupus nephritis: a study of 32 pregnancies from a single centre Ann Rheum Dis, June 1, 2001; 60(6): 599 - 604. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Mosca, R Neri, S Giannessi, A Pasquariello, R Puccini, W Bencivelli, and S Bombardieri Therapy with pulse methylprednisolone and short course pulse cyclophosphamide for diffuse proliferative glomerulonephritis Lupus, April 1, 2001; 10(4): 253 - 257. [Abstract] [PDF]
|
|
|
|
|
|
K Takada, G G Illei, and D T Boumpas Cyclophosphamide for the treatment of systemic lupus erythematosus Lupus, March 1, 2001; 10(3): 154 - 161. [Abstract] [PDF]
|
|
|
|
|
|
D Adu, J Cross, and D R. Jayne Treatment of systemic lupus erythematosus with mycophenolate mofetil Lupus, March 1, 2001; 10(3): 203 - 208. [Abstract] [PDF]
|
|
|
|
|
|
M Petri Exogenous estrogen in systemic lupus erythematosus: oral contraceptives and hormone replacement therapy Lupus, March 1, 2001; 10(3): 222 - 226. [Abstract] [PDF]
|
|
|
|
 |
|
 C C Mok and R W S Wong Pregnancy in systemic lupus erythematosus Postgrad. Med. J., March 1, 2001; 77(905): 157 - 165. [Abstract] [Full Text]
|
|
|
|
|
|
C. Auzary, D. l. T. Huong, B. Wechsler, D. Vauthier-Brouzes, and J.-C. Piette Pregnancy in patients with Wegener's granulomatosis: report of five cases in three women Ann Rheum Dis, October 1, 2000; 59(10): 800 - 804. [Abstract] [Full Text]
|
|
|
|
|
|
H. C. Nossent and W. Koldingsnes Long-term efficacy of azathioprine treatment for proliferative lupus nephritis Rheumatology, September 1, 2000; 39(9): 969 - 974. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Petri The egg and I: preserving fertility in systemic lupus erythematosus Lupus, July 1, 2000; 9(6): 399 - 400. [PDF]
|
|
|
|
|
|
D. Jayne Evidence-based treatment of systemic vasculitis Rheumatology, June 1, 2000; 39(6): 585 - 595. [Full Text] [PDF]
|
|
|
|
 |
|
 N. M. Janssen and M. S. Genta The Effects of Immunosuppressive and Anti-inflammatory Medications on Fertility, Pregnancy, and Lactation Arch Intern Med, March 13, 2000; 160(5): 610 - 619. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Corzillius and S-C Bae Methodological issues of corticosteroid use in SLE clinical trials Lupus, October 1, 1999; 8(8): 692 - 697. [Abstract] [PDF]
|
|
|
|
|
|
R. M. Laxer Long-term toxicity of immune suppression in juvenile rheumatic diseases Rheumatology, August 1, 1999; 38(8): 743 - 746. [Full Text] [PDF]
|
|
|
|
|
|
E. Cretel, P. Cacoub, D. L. Thi Huong, A. Gompel, Z. Amoura, and J.-C. Piette Massive ovarian haemorrhage complicating oral anticoagulation in the Antiphospholipid Syndrome: a report of three cases Lupus, July 1, 1999; 8(6): 482 - 485. [Abstract] [PDF]
|
|
|
|
 |
|
 M. OSTENSEN Sex Hormones and Pregnancy in Rheumatoid Arthritis and Systemic Lupus Erythematosus Ann. N.Y. Acad. Sci., June 22, 1999; 876(1): 131 - 144. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. CAMERON Lupus Nephritis J. Am. Soc. Nephrol., February 1, 1999; 10(2): 413 - 424. [Full Text]
|
|
|
|
|
|
C A Slater, M H Liang, J W McCune, G M Christman, and M R Laufer Preserving ovarian function in patients receiving cyclophosphamide Lupus, January 1, 1999; 8(1): 3 - 10. [PDF]
|
|
|
|
 |
|
 M. E. Fleischli, R. H. Valek, and A. G. Pandya Pulse Intravenous Cyclophosphamide Therapy in Pemphigus Arch Dermatol, January 1, 1999; 135(1): 57 - 61. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J M Gloor Lupus nephritis in children Lupus, November 1, 1998; 7(9): 639 - 643. [Abstract] [PDF]
|
|
|
|
|
|
A Zonana-Nacach, A Camargo-Coronel, P Yanez, M de Lourdes Sanchez, F J Jaimenez-Balderas, J Aceves-Avila, P Martinez-Osuna, J Fuentes, F Medina, and A Fraga Measurement of damage in 210 Mexican patients with systemic lupus erythematosus: relationship with disease duration Lupus, February 1, 1998; 7(2): 119 - 123. [Abstract] [PDF]
|
|
|
|
|
|
I. Martin-Suarez, D. D'Cruz, M. Mansoor, A. P. Fernandes, M. A Khamashta, and G. R V Hughes Immunosuppressive treatment in severe connective tissue diseases: effects of low dose intravenous cyclophosphamide Ann Rheum Dis, August 1, 1997; 56(8): 481 - 487. [Abstract] [Full Text]
|
|
|
|
 |
|
 |
Article
