Background/Purpose:

Systemic Lupus Erythematosus (SLE) frequently affects women in childbearing age; disease related factors and treatment can interfere with ovarian function. Anti-Mullerian-hormone (AMH) levels are considered a surrogate marker of the ovarian reserve in pre-menopausal women. In this study we aimed at evaluating AMH levels in SLE patients and at establishing possible correlations with disease variables, therapies and obstetrical history

Methods:

AMH levels were assessed in pre-menopausal SLE patients with an enzymatically amplified two-site immunoassay (AMH Gen II ELISA; Beckman Coulter). According to the published literature in healthy subjects, values 1 to 8 ng/mL indicate normal, values < 1ng/mL indicate reduced and <0.4 strongly reduced ovarian reserve. Demographic data, clinical variables, disease activity, ongoing therapies as well as cumulative glucocorticoids dosage (GC) and previous therapy with Cyclophsphamide (Cyc) at the time of AMH evaluation were collected from clinical charts. Obstetrical history and menopausal status at the end of follow up were also considered.

Results:

Seventy-five SLE patients were examined (mean age and disease duration 32.9±7 and 9.4 ±6 years respectively);  58 (77.3%) presented a history of renal involvement and 44 (58.6%) had received Cyc before AMH assay (mean cumulative dosage 7.31±6 g, intravenous in 33, oral in 8, both regimens in 3). The median time between the latest Cyc administration and AMH determination was 6.3 years (±5.5). At study entry, the mean GC dosage was 5.9 mg (±6.9) and the mean cumulative dosage was 14.9 (±11); 35 (46%) patients were receiving immunosuppressants. AMH values were within the normal ranges in 23 (30.6%) patients, reduced in 16 (21.3%) and strongly reduced in 36 (48%). AMH levels were inversely related to age (p=0.0001) and disease duration (p=0.004) and to previous therapy with Cyc (p=0.03). At the end of follow-up, 48 patients (64%) had at least one pregnancy and 4 (5%) were in menopause (2 premature ovarian failures). No relationships were observed between AMH levels and disease activity or cumulative GC. AMH levels were not correlated with the occurrence of pregnancy but were significantly associated with the number of pregnancies (p=0.03).

Conclusion:

In our cohort, a high percentage of patients presented low or very low levels of AMH; as expected, a significant decrease with age progression have been observed and previous therapy with Cyc seem to be important contributors. The association of AMH levels and the number of subsequent pregnancies supports the significance of this testing to assess ovarian reserve in these patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/anti-mullerian-hormone-in-patients-with-systemic-lupus-erythematosus/