Fertility preservation in patients receiving gonadotoxic therapies for systemic autoimmune diseases in Japan

Abstract

Objectives

Gonadotoxic therapies, mainly cyclophosphamide, are used for the treatment of various systemic autoimmune diseases. In Japan, the number of patients who undergo gonadotoxic therapy for autoimmune diseases, fertility preservation procedures performed in these patients, and problems associated with performing such procedures have not been reported. This study was performed to address these issues.

Methods

A questionnaire was sent to Certified Educational Facilities of the Japanese Society of Rheumatology, and a single rheumatologist at each center completed the questionnaire.

Results

A total of 63 facilities completed the questionnaire. Between April 2014 and March 2019, a total of 1302 men and premenopausal women had received gonadotoxic therapies for systemic autoimmune disease. Nearly half of the respondents reported that gonadotropin releasing hormone analog therapy was available in their area. However, the availability of other fertility preservation procedures was limited, and the number of patients undergoing fertility preservation procedures was limited. 85.7% of the respondents responded that measures to preserve fertility in patients receiving gonadotoxic therapies for autoimmune diseases were inadequate.

Conclusions

A substantial number of patients are receiving gonadotoxic therapies for the treatment of autoimmune diseases in Japan, and those patients may not be receiving adequate care regarding their fertility.

Keywords:

• Autoimmune diseases
• cyclophosphamide
• fertility

Acknowledgement

We would like to express our gratitude to all the rheumatologists at Certified Educational Facilities of the Japanese Society of Rheumatology and to their patients for their cooperation with this study. We would like to thank Dr. Takeuchi Tsutomu for his invaluable support and advice. We would also like to thank Mr. Hirayama of the Japanese Society for Rheumatology for his assistance in distributing the questionnaire.

Conflict of interest

Y. Tsuchida has received fees from GlaxoSmithKline. M. Harada has received grants, consulting fees, and/or speaking fees from Takeda Science Foundation, Yakult Bio-Science Foundation, Mitsubishi Paper Mills, Ferring Pharmaceuticals, Bayer, Fuji Pharma, Nippon Shinyaku, Kaken Pharmaceuticals, Mochida, Asuka, Chugai Pharmaceuticals, and Novo Nordisk. H. Shoda has received fees from Pfizer, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Chugai, UCB, and Daiichi-Sankyo. N. Suzuki has received grants from Morinaga, Astellas, Aska, and Hearzest. A. Murashima has received research grants from Astellas Pharma Inc. and Chugai Pharmaceutical Co. Ltd., and has received lecture fees from Astellas Pharma Inc., Chugai Pharmaceutical Co. Ltd., and Bristol-Myers K.K. Y. Osuga has received grants, consulting fees, and/or speaking fees from Mochida, Otsuka, Fuji Pharma, Bayer, Asuka, Nippon Shinyaku, Nobelpharma. K. Fujio has received grants, consulting fees, speaking fees, and/or honoraria from Takeda, Bristol-Myers Squibb, Mitsubishi Tanabe, Asahi Kasei, Sanofi, Eli Lilly, Daiichi-Sankyo, Ono, Janssen, AbbVie, Astellas, Eisai, Pfizer, Chugai, Novartis, UCB, Tsumura, Taisho Toyama, Nihon Kayaku, and Ayumi. Other authors declare no competing financial interests.

Additional information

Funding

This study was supported by Health and Labour Sciences Research Grant 19DA1004.