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Predictors of premature gonadal failure in patients with systemic lupus erythematosus. Results from LUMINA, a multiethnic US cohort (LUMINA LVIII)

¹ Department of Medicine (Division of Clinical Immunology and Rheumatology), Schools of Medicine And Public Health, University of Alabama, Birmingham, Alabama, USA
² Department of Surgery (Section of Trauma, Burns and Critical Care) and Epidemiology, Schools of Medicine And Public Health, University of Alabama, Birmingham, Alabama, USA
³ Department of Medicine (Division of Rheumatology), University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
⁴ Department of Medicine (Division of Rheumatology), University of Texas Health Science Center, Houston, Texas, USA

Correspondence to:
Dr G S Alarcón, 830 Faculty Office Tower, 510 20th Street South, Birmingham, Alabama 35294-3408, USA; graciela.alarcon{at}ccc.uab.edu

ABSTRACT
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.