[Role of gonadotropin releasing hormone analogues for ovarian protection in systemic lupus erythematosus patients treated with cyclophosphamide].
OBJECTIVE
To evaluate the effectiveness of gonadotropin releasing hormone analogues (GnRH-a) in protection against premature ovarian failure during cyclophosphamide (CTX) therapy for systemic lupus erythematosus (SLE).


METHODS
28 female patients with SLE, aged 35.3 +/- 2.4 (30-39) were treated with prednisone orally 1 mg/kg daily for 8 weeks, and then the dose was decreased by 10% every 10 days. CTX 200 mg with normal saline 200 ml was intravenously injection every other day for 4 months. Peripheral white blood cell (WBC) count was made every week. If the WBC count was less than 3.5 x 10(9)/L, the use of CTX should be stopped temporarily until the WBC count became normal. And then, the CTX administration should be adjusted to 400 mg intravenously every week. All patients were offered treatment with Hypodermic injection of GnRH-a 3.75 mg was given monthly just at the beginning of the standard CTX regimen for 3 months. Follow-up was conducted for 6 months after the last prescription of GnRH-a.


RESULTS
All patients developed amenorrhea after treated by GnRH-a. Menstruation recovered 73 days (69-82 days) after the last subcutaneous injection in 25 patients. Among these 25 patients, one developed amenorrhea again after two normal menses periods. The other 3 patients were in persistent amenorrhea during the following 6 months after the GnRH-a treatment. The levels of plasma estradiol (E2) was 998 +/- 308 pmol/L before GnRH-a treatment, and decreased significantly 1, 2, and 3 months after the last injection of GnRH-a (132 +/- 44 pmol/L, 88 +/- 37 pmol/L and 81 +/- 29 pmol/L respectively, all P < 0.05). The level of plasma E2 increased 2 months after the last injection of GnRH-a in the 25 patients with return of menses, and the level of plasma E2 returned to the normal baseline level after 6 months in 24 patients.


CONCLUSIONS
Treatment with GnRH-a during CTX therapy is associated with a significant reduction of premature ovarian failure in most women with SLE.
Liang
Liu-qin
LQ
Department of Rheumatology and Clinical Immunology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
Qiu
Qian
Q
Yang
Xiu-yan
XY
Xu
Han-shi
HS
Ye
Yu-jin
YJ
Zhan
Zhong-ping
ZP
Lian
Fan
F
Chen
Dong-ying
DY