A Comparison of Risk of Ovarian Failure Following Intravenous Cyclophosphamide Therapy in Juvenile versus Adult Systemic Lupus Erythematosus

shefali sharma¹, Hemanth Chinthala ², siddharth Jain ², Arghya Chattopadhyay ², Pooja Bahl ², Varun Dhir ³, naresh Sachdeva ² and Surjit Singh ⁴, ¹Dr., Chandigarh, Chandigarh, India, ²Post Graduate Institute of Medical Education and Research, chandigarh, Chandigarh, India, ³Post Graduate Institute of Medical Education and Research, Chandigarh, India, ⁴Allergy Immunology Unit, Department pf Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Adverse events, autoimmune diseases and Lupus, Autoimmunity

Session Information

Date: Tuesday, November 12, 2019

Session Title: SLE – Clinical Poster III: Treatment

Session Type: Poster Session (Tuesday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Premature ovarian failure is a dreaded complication of cyclophosphamide (CYC). It is related to age of initiation of therapy and the cumulative dose. This study was done to evaluate and compare the prevalence of ovarian failure in adult SLE(aSLE) and juvenile SLE(jSLE) post CYC .

Methods: : jSLE and aSLE patients post CYC therapy were enrolled. Their medical records were reviewed and cumulative dose and duration of CYC therapy noted. A detailed menstrual history was sought and serum levels of FSH, LH, E2, AMH, Inhibin and ultrasonography for ovarian volume and follicular count was done between 3-5 days of menstrual cycle.

Results: Twenty eight (14 jSLE, 14 aSLE) patients were included. The mean age was 14.79 ± 4.7 years and 29.07 ± 5.7 years respectively. Mean cumulative dose of CYC was 3996.4 ± 1800 mg in jSLE , and 5235.7 ± 2563.6 mg in aSLE

Among 14 jSLE patients, 12 had not attained menarche when CYC was administered, and all of them subsequently attained menarche (Mean age = 14.78 ± 2.33 years). Two patients in the jSLE group developed menstrual abnormalities: 1 had transient amenorrhea which recovered in 3 monthsof stopping CYC, the other developed persistent oligomenorrhea, although with normal AMH. Among 14 aSLE patients, 11 developed menstrual abnormalities after initiating CYC which recovered to normal in 8 patients. Three patients continued to have oligomenorrhea . Serum levels of FSH, LH, E2, AMH, Inhibin and ultrasound for ovarian volume and follicular count have been summarized in Table 1&2.

Conclusion: There was no delay in attainment of menarche in jSLE patients who received CYC before menarche. None of the patients developed overt ovarian failure in either jSLE or aSL, although persistence of oligomenorrhea was noted in a few patients.

Table 1

Table2

*cSLE ovarian volume was calculated in 11 patients out of 14 patients and three patients had small or streaky ovaries. **aSLE ovarian volume was calculated in 11 patients out of 14 patients and two patients had polycystic ovaries and in one patient ovaries were not visible.

Disclosure: s. sharma, None; H. Chinthala, None; s. Jain, None; A. Chattopadhyay, None; P. Bahl, None; V. Dhir, None; n. Sachdeva, None; S. Singh, None.

To cite this abstract in AMA style:

sharma s, Chinthala H, Jain s, Chattopadhyay A, Bahl P, Dhir V, Sachdeva n, Singh S. A Comparison of Risk of Ovarian Failure Following Intravenous Cyclophosphamide Therapy in Juvenile versus Adult Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/a-comparison-of-risk-of-ovarian-failure-following-intravenous-cyclophosphamide-therapy-in-juvenile-versus-adult-systemic-lupus-erythematosus/. Accessed May 29, 2020.

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