High doses of triptorelin are needed to maintain complete ovarian suppression in adolescent females with childhood-onset systemic lupus erythematosus who require cyclophosphamide, according to Dr. Hermine Brunner and her associates.

They conducted a trial in which 31 patients were randomized 4:1 in double-blind fashion to four different starting doses of triptorelin between 25 and 100 mcg/kg of body weight (up to 150 mcg/kg body weight or 20 g/dose) or placebo. If complete ovarian suppression (COS), based on a gonadotropin-releasing hormone test, was not achieved with the first dose, triptorelin dosing was increased by 25% or at least 20 mcg/kg every 4 weeks until COS was achieved.

Sustained COS was achieved in 90% of patients with a triptorelin dosage of 120 mcg/kg of body weight. COS was achieved 22 days after the initial triptorelin dosage. Adverse and serious adverse events occurred at statistically similar rates in the triptorelin and placebo groups.

The initial dose of triptorelin should be injected 4-6 days after a cyclophosphamide infusion to ensure that the medication has been cleared, and at least 22 days should pass after the first triptorelin injection before continuing with cyclophosphamide, the investigators recommended.

Find the full study at Arthritis & Rheumatology ( doi:10.1002/art.39024 ).