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GnRH agonist may curb ovarian failure in lupus.(Obstetrics)
SNOWMASS, COLO. -- A gonadotropin-releasing hormone agonist can prevent ovarian failure in lupus patients on cyclophosphamide, according to a small, case-control study conducted at the University of Michigan.
Evidence suggests that by the time a patient with lupus has taken a total 30 g of cyclophosphamide (equivalent to about a year of treatment at 100 mg a day) the rate of ovarian failure is about 70%, W. Joseph McCune, M.D., said at a symposium sponsored by the American College of Rheumatology.
The regimen can also result in cervical dysplasia, which is why patients started on cyclophosphamide should have a Pap smear early in the course of their treatment, advised Dr. McCune, a lupus expert and the codirector of the nephrology/rheumatology vasculitis clinic at the University of Michigan, Ann Arbor.
In their prospective study, Dr. McCune and his colleagues enrolled 40 patients with lupus nephritis or severe systemic lupus erythematosus (SLE), whose average age was 23 years. Their regimen was sequential, with monthly intravenous cyclophosphamide for 6 months followed by a switch to azathioprine and then mycophenolate mofetil. If the disease did not respond after 6 months of cyclophosphamide, patients were treated with 4 more months of cyclophosphamide.
Among the 20 patients treated with leuprolide acetate in depot suspension (Lupron, 3.75 mg a month), only 1 developed ovarian failure at the end of 3 years, compared with 6 of 20 matched women who did not receive GnRH.
Treatment-group patients received their first monthly injection of depot leuprolide acetate after receiving their first dose of cyclophosphamide, and the hormone agonist therapy was readministered after each course of cyclophosphamide--including when the patients had a flare after initial treatment and had to go back on the alkylating agent.
Patients who developed menopausal symptoms from the GnRH agonist were given an estrogen patch, together with depot medroxyprogesterone acetate (Depo Provera) to prevent a pregnancy.
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