Benefits of Intravenous Cyclophosphamide May Outweigh Mild Risk of Ovarian Dysfunction in Young Women with Severe Lupus
The benefits of moderate dose intravenous cyclophosphamide (CYC) immunosuppressive therapy, a preferred treatment for severe lupus, may outweigh concerns of risk of ovarian dysfunction in young women with lupus with severe life- or organ-threatening disease.
Researchers evaluated CYC therapy which, in recent years, moved from oral to intravenous administration at lower doses for a shorter duration, offering better markers of ovarian reserve, the capacity of the ovary to provide egg cells capable of fertilization, to review. Previous studies, dating back 20 years or more, indicated incidence of ovarian failure with CYC between 11% and 59%, leading to its restriction among young women who want to grow their families.
The study compared measures of ovarian function between 50 female patients ages 18-40 with severe lupus – half of the patients received monthly intravenous CYC and the other half received daily oral mycophenolate mofetil (MMF). The CYC group experienced greater menstrual irregularities (56%) compared to the MMF group (28%), but only 4% of the CYC group continued to experience amenorrhea, one or more missed menstrual periods, at 1 year. Hormone levels and ovarian volume were negatively impacted within six months of CYC therapy; however, no premature ovarian failure was noted at 1 year in either group. Lupus disease activity did not impact ovarian function or reserve.
While use of CYC has been shown to negatively impact ovarian function compared to MMF, the effect is milder than previously understood and may justify its use among young women with severe lupus. Risk factors for developing ovarian failure after receiving CYC include older age, higher cumulative dose, and longer treatment duration. Learn more about women’s health and reproductive issues with lupus.