Fertility Preservation By Identifying Women With SLE At High Risk Of Ovarian Toxicity On Exposure To Cyclophosphamide By Determination Of CYP2C19 Genotype

Fatma Alaetebi, Zeinb Othman, Rasha Elrefaie, Liala Rashed, Nashwa Taher

Abstract


Objective: to study the association of cytochrome P450 (CYP2C19) polymorphism with the ovarian toxicity, as well as, the clinical response in patients with systemic lupus erythematosus treated with intravenous cyclophosphamide.

Design: cross sectional study

Participants and methods: This study was conducted at a tertiary referral center and included forty seven systemic lupus erythematosus (SLE) women receiving cyclophosphamide and twenty matching control were subjected to hormonal profile and CYP2C19 Genotype, after that, all patients were followed up for menstrual pattern.

Results: The association between cytochrome P450 (CYP2C19) genotypes of SLE patients as regards the incidence of ovarian toxicity among them was significant P=0.02. The percentage of patients having no ovarian toxicity with the wild type of CYP2C19 was 25.72%, compared to 45.71% with variant homozygous type of CYP2C19, while those with variant heterozygous type were 28.57%. The percentage of patients having ovarian failure with the wild type of CYP2C19 was 85.71% compared to 0% with variant homozygous type of CYP2C19, while those with variant heterozygous type were 14.29%. The sensitivity of the wild type as a predictor for ovarian toxicity is 85.7%, while the specificity is 25.7%.

Conclusion: it is possible to predict which patient with SLE could be of high risk of ovarian toxicity on exposure to cyclophosphamide by determination of CYP2C19 genotype.

Keywords: SLE, Fertility preservation, Cyclophosphamide, Ovarian toxicity.


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