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Immune drug tied to miscarriage in lupus patients

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Reuters Health

Monday, August 25, 2008

NEW YORK (Reuters Health) - The use of the immune-suppressing drug cyclophosphamide increases the risk of miscarriage in young women with systemic lupus erythematosus who have unplanned pregnancies, according to findings from a Brazilian study.

Systemic lupus erythematosus is an autoimmune disease, a chronic disease in which the body's immune system attacks itself. The disease, which can affect any part of the body and has an unpredictable course, is most common among women. The symptoms vary depending on what organs are affected, but often they mimic those seen with other diseases, making diagnosis difficult. Although there is no cure, the disease can be treated with immune-suppressing drugs.

As reported in the Journal of Rheumatology, Dr. Clovis A. A. Silva, of the University of Sao Paulo, and colleagues examined pregnancy outcomes among 298 female patients followed in 12 Brazilian pediatric rheumatology centers.

A total of 24 unplanned pregnancies were reported at an average age of 18 years. Of the 24 pregnancies, 18 resulted in live births, 5 were miscarriages, and 1 resulted in death due to later complications and premature birth.

Lupus severity at the start of pregnancy was significantly greater in women who miscarried compared with those who gave birth to a live infant. Further analysis showed that use of intravenous cyclophosphamide at the start of pregnancy increased the odds of miscarriage by nearly 26-fold.

While the findings reinforce the importance of contraception when lupus patients require cyclophosphamide, Silva and colleagues conclude, "consideration should also be given to supporting young women with lupus who are in a period of relatively good health to fulfill their desire for a pregnancy at a time when the chance of a good outcome is at its highest."

SOURCE: Journal of Rheumatology, July 2008.

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