Skip to main content
Journal cover image

Ovarian reserve diminished by oral cyclophosphamide therapy for granulomatosis with polyangiitis (Wegener's).

Publication ,  Journal Article
Clowse, MEB; Copland, SC; Hsieh, T-C; Chow, S-C; Hoffman, GS; Merkel, PA; Spiera, RF; Davis, JC; McCune, WJ; Ytterberg, SR; St Clair, EW ...
Published in: Arthritis Care Res (Hoboken)
December 2011

OBJECTIVE: Standard treatment for severe granulomatosis with polyangiitis (Wegener's) (GPA) is daily oral cyclophosphamide (CYC), a cytotoxic agent associated with ovarian failure. In this study, we assessed the rate of diminished ovarian reserve in women with GPA who received CYC versus methotrexate (MTX). METHODS: Patients in the Wegener's Granulomatosis Etanercept Trial received either daily CYC or weekly MTX and were randomized to etanercept or placebo. For all women ages <50 years, plasma samples taken at baseline or early in the study were evaluated against samples taken later in the study to compare levels of anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH), endocrine markers of remaining egg supply. Diminished ovarian reserve was defined as an AMH level of <1.0 ng/ml. RESULTS: Of 42 women in this analysis (mean age 35 years), 24 had CYC exposure prior to enrollment and 28 received the drug during the study. At study entry, women with prior CYC exposure had significantly lower AMH, higher FSH, and a higher rate of early menstruation cessation. For women with normal baseline ovarian function, 6 of 8 who received CYC during the trial developed diminished ovarian reserve, compared to 0 of 4 who did not receive CYC (P < 0.05). Changes in AMH correlated inversely with cumulative CYC dose (P < 0.01), with a 0.74 ng/ml decline in AMH level for each 10 gm of CYC. CONCLUSION: Daily oral CYC, even when administered for less than 6 months, causes diminished ovarian reserve, as indicated by low AMH levels. These data highlight the need for alternative treatments for GPA in women of childbearing age.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Arthritis Care Res (Hoboken)

DOI

EISSN

2151-4658

Publication Date

December 2011

Volume

63

Issue

12

Start / End Page

1777 / 1781

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Treatment Outcome
  • Time Factors
  • Receptors, Tumor Necrosis Factor
  • Primary Ovarian Insufficiency
  • Ovary
  • Middle Aged
  • Methotrexate
  • Immunosuppressive Agents
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Clowse, M. E. B., Copland, S. C., Hsieh, T.-C., Chow, S.-C., Hoffman, G. S., Merkel, P. A., … WGET Research Group, . (2011). Ovarian reserve diminished by oral cyclophosphamide therapy for granulomatosis with polyangiitis (Wegener's). Arthritis Care Res (Hoboken), 63(12), 1777–1781. https://doi.org/10.1002/acr.20605
Clowse, Megan E. B., Susannah C. Copland, Tsung-Cheng Hsieh, Shein-Chung Chow, Gary S. Hoffman, Peter A. Merkel, Robert F. Spiera, et al. “Ovarian reserve diminished by oral cyclophosphamide therapy for granulomatosis with polyangiitis (Wegener's).Arthritis Care Res (Hoboken) 63, no. 12 (December 2011): 1777–81. https://doi.org/10.1002/acr.20605.
Clowse MEB, Copland SC, Hsieh T-C, Chow S-C, Hoffman GS, Merkel PA, et al. Ovarian reserve diminished by oral cyclophosphamide therapy for granulomatosis with polyangiitis (Wegener's). Arthritis Care Res (Hoboken). 2011 Dec;63(12):1777–81.
Clowse, Megan E. B., et al. “Ovarian reserve diminished by oral cyclophosphamide therapy for granulomatosis with polyangiitis (Wegener's).Arthritis Care Res (Hoboken), vol. 63, no. 12, Dec. 2011, pp. 1777–81. Pubmed, doi:10.1002/acr.20605.
Clowse MEB, Copland SC, Hsieh T-C, Chow S-C, Hoffman GS, Merkel PA, Spiera RF, Davis JC, McCune WJ, Ytterberg SR, St Clair EW, Allen NB, Specks U, Stone JH, WGET Research Group. Ovarian reserve diminished by oral cyclophosphamide therapy for granulomatosis with polyangiitis (Wegener's). Arthritis Care Res (Hoboken). 2011 Dec;63(12):1777–1781.
Journal cover image

Published In

Arthritis Care Res (Hoboken)

DOI

EISSN

2151-4658

Publication Date

December 2011

Volume

63

Issue

12

Start / End Page

1777 / 1781

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Treatment Outcome
  • Time Factors
  • Receptors, Tumor Necrosis Factor
  • Primary Ovarian Insufficiency
  • Ovary
  • Middle Aged
  • Methotrexate
  • Immunosuppressive Agents