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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. L A González1,
  2. G McGwin Jr2,
  3. S Durán1,
  4. G J Pons-Estel1,
  5. M Apte1,
  6. L M Vilá3,
  7. J D Reveille4,
  8. G S Alarcón1,2,
  9. for the LUMINA Study Group
  1. 1
    Department of Medicine (Division of Clinical Immunology and Rheumatology), Schools of Medicine And Public Health, University of Alabama, Birmingham, Alabama, USA
  2. 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. 3
    Department of Medicine (Division of Rheumatology), University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
  4. 4
    Department of Medicine (Division of Rheumatology), University of Texas Health Science Center, Houston, Texas, USA
  1. 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.

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Footnotes

  • Funding: Supported by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases p01 ar49084, General Clinical Research Centers m01-rr02558 (UTH) and m01-rr00032 (UAB) and from the National Center for Research Resources (NCRR/NIH) RCMI clinical research infrastructure initiative (RCRII) 1p20rr11126 (UPR) and by the STELLAR (supporting training efforts in lupus for Latin American rheumatologists) programme funded by Rheuminations, Inc (UAB). The work of LAG was also supported by Universidad de Antioquía, Medellín, Colombia.

  • Competing interests: None declared.

  • Ethics approval: Approved by the Institutional Review Boards for the Protection of Human Subjects.

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    BMJ Publishing Group Ltd and European League Against Rheumatism