Background/Purpose: To study the level of anti-mullerian hormone (AMH) and its relationship with age and previous cyclophosphamide (CYC) exposure in patients with systemic lupus erythematosus (SLE).

Methods: Consecutive female patients aged 18-52 years who had menstruation in the preceding 12 months and fulfilled ³4 ACR criteria for SLE were recruited.  AMH was assayed by an ELISA kit (Beckman Coulter, Inc., USA).  Serum AMH level was compared between patients with and without previous use of immunosuppressive agents. The relationship of AMH level to age and CYC exposure was studied by linear regression.

Results: 216 female SLE patients were studied. The mean age of patients at the time of venepuncture was 35.1±10.1 years and the mean SLE duration was 7.6±5.9 years.  Immunosuppressive drugs ever received by these patients were: prednisolone (90%), AZA (69%), MMF (30%), tacrolimus (21%), cyclosporin A (17%), CYC (22%) and HCQ (67%).  Prednisolone was exclusively used in combination with one or more of the other immunosuppressive drugs.  Of the 48 CYC users, 29 (40%) received daily oral treatment and 19 (40%) received monthly intravenous pulse therapy.  The median total duration of CYC exposure was 20 weeks (inter-quartile range [IQR] 12.3-32.8).  Fifty-four (25%) patients had undetectable AMH level (78% aged >40 years).  These patients were significantly older than those with measurable AMH level (median age 47 [IQR 42-51] vs 31 [IQR 25-38.3] years; p<0.001).  Significantly lower levels of AMH were observed for past users of CYC than non-users, after adjustment for age (1.58±2.92 vs 1.73±2.11 ng/mL; p=0.04 by ANCOVA).  The mean time interval between AMH assay and last dose of CYC administered was 6.28±3.8 years.  AMH levels were not statistically different between users and non-users of other immunosuppressive agents that included prednisolone, mycophenolate mofetil, azathioprine and the calcineurin inhibitors.  Linear regression revealed age (Beta -0.32; p=0.02) and each 5g of CYC exposure (Beta -0.28; p=0.047) were independently associated with lower AMH level.  The route of CYC administration, duration of CYC treatment, disease activity score and duration of SLE was not significantly associated with AMH level on univariate regression analyses.

Conclusion: AMH is a sensitive marker for ovarian damage due to previous CYC treatment in SLE patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/anti-mullerian-hormone-and-ovarian-reserve-in-systemic-lupus-erythematosus/