Fertility preservation methods in young women with systemic lupus erythematosus prior to cytotoxic therapy: experiences from the <i>Ferti</i>Protekt network

Henes, Melanie; Henes, JC; Neunhoeffer, E.; Wolff, Michael von; Schmalzing, Marc; Kötter, Ina; Lawrenz, Barbara

doi:10.1177/0961203312442753

Cited by 46 publications

(32 citation statements)

References 24 publications

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“…This risk may be associated with older age at time of treatment and higher cumulative intravenous CYC doses. The use of gonadotropinreleasing hormone agonists may increase ovarian preservation and fertility rates in women taking CYC for rheumatologic disease or malignancies (40) and should be discussed with women of childbearing age in whom CYC therapy is planned. Rituximab, MMF, and azathioprine are not felt to increase the risk of amenorrhea or infertility in females, and in the trials discussed here, no episodes of amenorrhea were noted in patients treated with rituximab for AAV.…”

Section: Infertilitymentioning

confidence: 99%

Is Newer Safer? Adverse Events Associated with First-Line Therapies for ANCA-Associated Vasculitis and Lupus Nephritis

Hogan

Avasare

2014

Clinical Journal of the American Society of Nephrology

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Clinical outcomes in ANCA-associated vasculitis (AAV) and lupus nephritis have improved greatly with treatment regimens containing high-dose glucocorticoids and cyclophosphamide. However, with the use of these medications come significant adverse events, most notably infections, cytopenias, malignancies, and reproductive abnormalities. Multiple recent randomized controlled trials in AAV and lupus nephritis have compared cyclophosphamide-based regimens with agents such as rituximab, mycophenolate mofetil, and azathioprine, with the hope of providing better clinical outcomes with improved safety profiles. Although some of these newer regimens are now considered first-line treatments of these diseases, their adverse event profiles have been disappointingly similar to those of cyclophosphamide-based protocols. Physicians and patients should consider the adverse event profiles generated by these trials in the context of their extensive use in other patient populations, as well as available measures to prevent such events, when choosing the ideal regimen for an individual patient.

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Section: Infertilitymentioning

confidence: 99%

Is Newer Safer? Adverse Events Associated with First-Line Therapies for ANCA-Associated Vasculitis and Lupus Nephritis

Hogan

Avasare

2014

Clinical Journal of the American Society of Nephrology

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“…Various strategies of fertility preservation treatment have been evaluated, but all are associated with a significant residual risk of infertility. In contrast, immunosuppressive therapy with MM and MTX is not expected to have long-term adverse effects on fertility once therapy has been completed [18]. …”

Section: Discussionmentioning

confidence: 99%

Encephalopathic Susac’s Syndrome associated with livedo racemosa in a young woman before the completion of family planning

Engeholm

Leo-Kottler

Rempp³

et al. 2013

BMC Neurol

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BackgroundSusac’s Syndrome (SS) consists of the triad of encephalopathy, branch retinal artery occlusions (BRAO) and hearing loss (HL). Histopathologically, SS is characterised by a microangiopathy, and some observations suggest that an immune-mediated damage of endothelial cells might play a role. These findings also implicate a similarity between SS and other autoimmune diseases, most notably juvenile dermatomyositis (JDM). However, SS and JDM are commonly thought to affect distinct and non-overlapping sets of organs, and it is currently not clear how these specificities arise. Moreover, in the absence of clinical trials, some authors suggest that therapeutic approaches in SS should rely on the model of other autoimmune diseases such as JDM.Case presentationHere, we report a case of SS in a 32-year-old pregnant woman. She initially was admitted to the hospital with subacute severe encephalopathy and multifocal neurologic signs. As cranial magnetic resonance imaging (MRI) revealed multifocal white matter lesions including the corpus callosum, erroneously a diagnosis of multiple sclerosis (MS) was made, and intravenous methylprednisolone (IVMP) therapy was initiated. A few days later, an exanthema appeared on the trunk and extremities, which was diagnosed as livedo racemosa (LR). Several weeks later, the patient was readmitted to the clinic with an obscuration of her left visual hemifield and a bilateral HL. Ophthalmologic examination revealed extensive ischemic damage to both retinae. Now the correct diagnosis of SS was established, based on the above triad of clinical symptoms in conjunction with typical MRI and fundoscopic findings. When SS was diagnosed, the standard therapy with intravenous cyclophosphamide (IVCTX) was not instituted because of a significant risk of permanent infertility. Instead, sustained control of disease activity could be achieved with a therapeutic regime combining prednisolone, intravenous immunoglobulins (IVIG), mycophenylate mofetil (MM), and methotrexate (MTX).ConclusionsAn association with LR has only been described in very few cases of SS before and further underlines the pathogenetic relationship between SS and other autoimmune diseases such as JDM. In young women with SS and the desire for a child the combination of MM and MTX may represent a reasonable alternative to IVCTX.

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“…Aus früherenStudienkanndas PJP-Risiko im Rahmen der Remissionsinduktion auf 6-20 % geschätzt werden, die hieraus resultierende Letalität beträgt bis zu 50 % der Betroffenen [102]. Als Hauptrisikofaktor ist eine GC-Dosis von >15 mg Prednisolonäquivalent/Tag für mehr als 1 Monat anzusehen [211] [31,81].…”

Section: Infektionsprophylaxe Während Der Remissionsinduktionunclassified

S1 guidelines Diagnostics and treatment of ANCA-associated vasculitis

Schirmer

Moosig²

2017

Z Rheumatol

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Fertility preservation methods in young women with systemic lupus erythematosus prior to cytotoxic therapy: experiences from the FertiProtekt network

Cited by 46 publications

References 24 publications

Is Newer Safer? Adverse Events Associated with First-Line Therapies for ANCA-Associated Vasculitis and Lupus Nephritis

Is Newer Safer? Adverse Events Associated with First-Line Therapies for ANCA-Associated Vasculitis and Lupus Nephritis

Encephalopathic Susac’s Syndrome associated with livedo racemosa in a young woman before the completion of family planning

S1 guidelines Diagnostics and treatment of ANCA-associated vasculitis

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