RISK-FACTORS FOR OVARIAN FAILURE IN PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS RECEIVING CYCLOPHOSPHAMIDE THERAPY

Objective. To determine the incidence of ovarian failure after cycloph osphamide (CYC) treatment for systemic lupus erythematosus (SLE) and t o identify the risk factors for this complication. Methods. The record s of 70 premenopausal female SLE patients treated with CYC were review ed retrospectively. Information on demographic features, autoantibody profiles, and CYC treatment was obtained, and comparisons were made be tween those who developed ovarian failure and those who did not, Data on the CYC-treated patients were also compared with data on 2 control groups of non-CYC-treated SLE patients, Results, Eighteen patients dev eloped ovarian failure after CYC treatment, for an overall incidence o f 26%. The incidence of ovarian failure showed a linear trend of incre ase with increasing age at the start of CYC (P = 0.007), The cumulativ e CYC dose was significantly higher in the patients with ovarian failu re than in those without (28.3 gm versus 15.4 gm; P = 0.004), The risk of ovarian failure also showed a linear trend of increase with increa sing cumulative CYC dose (P < 0.001), Using multiple logistic regressi on, the age at the time of CYC treatment initiation (beta = 0.37, SE = 0.11, P = 0.001) and the cumulative dose of CYC received (beta = 0.69 , SE = 0.29, P = 0.02) were found to be independent risk factors for C YC-induced ovarian failure, Conclusion. In our population of female SL E patients, CYC-induced ovarian toxicity is a significant problem, par ticularly in patients above the age of 40, The age at the start of CYC therapy and the cumulative dose are the major determinants for the de velopment of this complication. For older patients with SLE in whom th e use of CYC is warranted, a shorter course and lower dosage should be considered.