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.

中文翻译：

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对环磷酰胺的促性腺激素作用和促性腺激素释放激素激动剂（GnRHa）在具有自身免疫性风湿病的育龄妇女中的益处的系统评价和荟萃分析。

目的：系统评价自身免疫性风湿性疾病（ARD）中静脉内（IV）环磷酰胺持续闭经的风险，并评估促性腺激素释放激素激动剂（GnRHa）降低该风险的方法。 ARD持续性闭经≥12个月的患者：IV环磷酰胺；结果：从31篇文章和1388例平均年龄为27.7岁的患者中，有273例患者出现持续性闭经（19.7％）。在接受GnRHa和IV环磷酰胺治疗的56名患者（平均年龄范围23.9-25.6岁）和仅接受IV环磷酰胺治疗的37名对照（平均年龄范围25-30.1岁）中，接受GnRHa治疗的2/56（3.6％）患者出现持续闭经，与15/37（40。5％）控件。持续性闭经与GnRHa和环磷酰胺相比单独使用环磷酰胺的合并优势比为0.054（95％CI 0.0115-0.2576 p <0.001），对应于需要治疗的2.7（95％CI 1.955-4.388）和绝对风险降低36.95结论（95％CI 35.6-38.4％）。结论：ARD患者患有持续性闭经与IV环磷酰胺，尤其是随着年龄的增长和累积剂量> 5g。GnRHa降低了这种风险，育龄期ARD的妇女应考虑使用IV环磷酰胺。在ARD患者中观察到IV环磷酰胺持续闭经，尤其是随着年龄的增长和累积剂量> 5g。GnRHa降低了这种风险，育龄期ARD的妇女应考虑使用IV环磷酰胺。在ARD患者中观察到IV环磷酰胺持续闭经，尤其是随着年龄的增长和累积剂量> 5g。GnRHa降低了这种风险，育龄期ARD的妇女应考虑使用IV环磷酰胺。