Predictors of premature gonadal failure in patients with systemic lupus erythematosus. Results from LUMINA, a multiethnic US cohort (LUMINA LVIII).
OBJECTIVE
To examine the predictors of time to premature gonadal failure (PGF) in patients with systemic lupus erythematosus from LUMINA, a multiethnic US cohort.


METHODS
PGF was defined according to the SLICC Damage Index (SDI). Factors associated with time to PGF occurrence were examined by univariable and multivariable Cox proportional hazards regression analyses: three models according to cyclophosphamide use, at T0 (model 1), over time (model 2) and the total number of intravenous pulses (model 3).


RESULTS
Thirty-seven of 316 women (11.7%) developed PGF (19 Texan-Hispanics, 14 African-Americans, four Caucasians and no Puerto Rican-Hispanics). By multivariable analyses, older age at T0 (hazards ratio (HR) = 1.10-1.14; 95% CI 1.02-1.05 to 1.19-1.23) and disease activity (Systemic Lupus Activity Measure-Revised) in all models (HR = 1.22-1.24; 95% CI 1.10-1.12 to 1.35-1.37), Texan-Hispanic ethnicity in models 2 and 3 (HR = 4.06-5.07; 95% CI 1.03-1.25 to 15.94-20.47) and cyclophosphamide use in models 1 and 3 (1-6 pulses) (HR = 4.01-4.65; 95% CI 1.55-1.68 to 9.56-13.94) were predictors of a shorter time to PGF.


CONCLUSIONS
Disease activity and Texan-Hispanic ethnicity emerged as predictors of a shorter time to PGF while the associations with cyclophosphamide use and older age were confirmed. Furthermore, cyclophosphamide induction therapy emerged as an important determinant of PGF.
González
L A
LA
Department of Medicine (Division of Clinical Immunology and Rheumatology), Schools of Medicine And Public Health, University of Alabama, Birmingham, Alabama, USA.
McGwin
G
G
Durán
S
S
Pons-Estel
G J
GJ
Apte
M
M
Vilá
L M
LM
Reveille
J D
JD
Alarcón
G S
GS
D000208:Acute Disease; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D003520:Cyclophosphamide / Q000009:adverse effects; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000208:ethnology / Q000276:immunology*; D008594:Menopause, Premature / Q000208:ethnology / Q000276:immunology*; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012306:Risk; D044465:White People
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide