Luong, S-N;
Isaacs, A;
Sin, FE;
Giles, I;
(2020)
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.
Expert Review of Clinical Immunology
, 16
(3)
pp. 321-333.
10.1080/1744666X.2020.1724091.
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A systematic review and meta analysis of the gonadotoxic effects of cyclophosphamide and benefits of gonadotropin releasing hormone agonists GnRHa in.pdf - Accepted Version Download (1MB) | Preview |
Abstract
Objectives: To systematically review the risk of sustained amenorrhoea with intravenous (IV) cyclophosphamide in autoimmune rheumatic disease (ARD), and evaluate the efficacy of gonadotropin releasing hormone agonists (GnRHa) to reduce this risk. / Methods: Systematic search for papers reporting the incidence of sustained amenorrhoea ≥ 12 months in ARD following: IV cyclophosphamide; or GnRHa and IV cyclophosphamide compared to IV cyclophosphamide alone. / Results: From 31 articles and 1388 patients with a mean age of 27.7 years, sustained amenorrhoea 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 amenorrhoea occurred in 2/56 (3.6%) patients treated with GnRHa, compared to 15/37 (40.5%) controls. Pooled odds ratio of sustained amenorrhoea with GnRHa and cyclophosphamide versus cyclophosphamide alone was 0.054 (95% CI 0.0115-0.2576 p<0.001), corresponding to a number needed to treat of 2.7 (95% CI 1.955-4.388) and absolute risk reduction of 36.95% (95% CI 35.6-38.4%). / Conclusion: Sustained amenorrhoea with IV cyclophosphamide was observed in patients with ARD, especially with increasing age and cumulative doses >5g. GnRHa reduced this risk and should be considered with IV cyclophosphamide in women of childbearing age with ARD.
| Type: | Article |
|---|---|
| Title: | 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 |
| Event: | Annual Conference of the British-Soceity-for-Rheumatology |
| Location: | Birmingham, ENGLAND |
| Dates: | 30 April 2019 - 02 May 2019 |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1080/1744666X.2020.1724091 |
| Publisher version: | https://doi.org/10.1080/1744666X.2020.1724091 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Sustained amenorrhea, cyclophosphamide, gonadotropin-releasing hormone agonists, rheumatic disease |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inflammation |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10091188 |
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