1. A systematic review and meta-analysis of the gonadotoxic effects of cyclophosphamide and benefits of gonadotropin releasing hormone agonists (GnRHa) in women of child-bearing age with autoimmune rheumatic disease
- Author
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Zhixin Liu, Ian Giles, Fang E Sin, Anthony Isaacs, and Shi-Nan Luong
- Subjects
0301 basic medicine ,Adult ,Risk ,medicine.medical_specialty ,Cyclophosphamide ,Drug-Related Side Effects and Adverse Reactions ,Immunology ,Gonadotropin-releasing hormone ,Autoimmune Diseases ,Gonadotropin-Releasing Hormone ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Rheumatic Diseases ,medicine ,Immunology and Allergy ,Humans ,Amenorrhea ,030203 arthritis & rheumatology ,business.industry ,Incidence (epidemiology) ,Rheumatic disease ,Odds ratio ,030104 developmental biology ,Meta-analysis ,Administration, Intravenous ,Female ,medicine.symptom ,business ,Hormone ,medicine.drug - Abstract
Objectives: To systematically review risk of sustained amenorrhea with intravenous (IV) cyclophosphamide in autoimmune rheumatic disease (ARD), and evaluate efficacy of gonadotropin-releasing hormone agonists (GnRHa) to reduce this risk.Methods: Systematic search for papers reporting incidence of sustained amenorrhea ≥12 months in ARD following: IV cyclophosphamide; or GnRHa and IV cyclophosphamide compared to IV cyclophosphamide alone.Results: From 31 articles and 1388 patients (mean age 27.7 years) sustained amenorrhea occurred in 273 patients (19.7%). Of 56 patients (mean age range 23.9-25.6 years) receiving GnRHa and IV cyclophosphamide, and 37 controls (mean age range 25-30.1 years) given IV cyclophosphamide only, sustained amenorrhea occurred in 2/56 (3.6%) patients treated with GnRHa, compared to 15/37 (40.5%) controls. Pooled odds ratio of sustained amenorrhea with GnRHa and cyclophosphamide versus cyclophosphamide alone was 0.054 (95% CI 0.0115-0.2576 p 5 g. GnRHa reduced this risk and should be considered with IV cyclophosphamide in women of childbearing age with ARD.
- Published
- 2020