AMENORRHEA IN A COHORT OF LUPUS PATIENTS TREATED WITH CYCLOPHOSPHAMIDE
Dalia Dorgham¹, Hisham Haggag²
Departments of ¹Rheumatology and Rehabilitation, and 2Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease hitting females during reproductive years. Major organ affection as lupus nephritis requires potent immunosuppressive treatment. Cyclophosphamide (CYC) has been widely used as an effective immunosuppressive agent in SLE. Premature ovarian failure is an important side effect of CYC treatment. Older age of SLE patient during treatment and increased duration of CYC exposure have been suggested as risk factors for ovarian failure. Patients and Methods: Forty lupus patients were included in this study, recruited from Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University. Patients were classified according to 2012 SLICC criteria. Apart from 2 patients who experienced hemorrhagic cystitis, 38 patients completed 6 CYC IV pulse doses separated by a month interval. Patients were followed up for development of amenorrhea during CYC treatment and 6 months after. Results: Out of patients who completed CYC treatment (n=38), 25 patients (65.7%) developed amenorrhea during CYC treatment for 2-4 cycles and regained regular cycle after finishing CYC. Seven patients (18.4%) developed sustained amenorrhea for more than 6 months while regular cycles were reported by 6 patients (15.7%). Conclusion: Ovarian failure is not an uncommon complication of CYC treatment. It is associated with older age of the patient (p=0.03).