Background/Purpose . Systemic lupus erythematosus (SLE) predominantly affects women of childbearing age, can lead to severe organ involvement and may require prolonged immunosuppressive therapy. Anti-Müllerian Hormone is produced by the granulosa ovary cells and serum levels of Anti-Müllerian Hormone  are used as a measure of ovarian reserve, reflecting the number of primary follicles. The aim of the study was to compare serum levels of AMH in a cohort of patients with SLE and healthy controls to assess whether the presence of the disease, the treatments used and/or other clinical parameters may affect the ovarian reserve.

Methods . 75 women with SLE of childbearing age, aged between 18 and 42 years and with regular menses, and 30 healthy controls age-matched (p=0.3) were evaluated.  Anti-Müllerian Hormone levels were measured in peripheral blood samples (kit AMH Gen II ELISA, Beckman Coulter). Clinical and demographic characteristics, disease duration, pattern of organ involvement and previous and current therapies were collected at the time of sampling. 14 patients (18.7%) had been treated with cyclophosphamide (cumulative dose 8.3 ± 5.4 g), and of the remaining, 36 (48.0%) with other DMARDs (methotrexate, azathioprine, mycophenolate mofetil, cyclosporine) and 25 (33.3%) with anti-malarials only. 

Results .  Patients with SLE had a mean age of 30.2±6.3 years, a disease duration of 8.4±5.1 and 25 patients (33.3%) had a severe organ involvement (mainly renal and neurological, 14 were treated with cyclophosphamide, 11 with other DMARDs). Serum levels of AMH were comparable between patients and controls (4.3±3.3 vs 5.2±3.2 ng/ml, respectively, p=0.15). Considering patients on the basis of organ involvement, patients with major organ involvement had AMH levels (3.4±2.7 ng/ml) significantly lower than control subjects (p = 0.04); no difference was found between patients with minor organ involvement (AMH 4.7±3.4 ng/ml) and control subjects (p=0.45). Considering the treatments used, patients with major organ involvement treated with cyclophosphamide showed serum AMH levels lower than controls (3.3±4.0 ng/ml, p=0.04) and tendentially lower than patients not treated with cyclophosphamide (3.3±4.0 vs 4.5±3.0, p=0.09). There were no associations between the use of other DMARDs than cyclophosphamide and lower AMH levels in SLE patients compared to controls.

Conclusion . In the whole cohort of SLE patients, the ovarian reserve was overall comparable to that of healthy controls, whereas a reduction of the ovarian reserve was associated with the use of cyclophosphamide and the severity of the disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/serum-anti-mullerian-hormone-levels-in-sle-patients-the-disease-severity-and-cyclophosphamide-reduce-the-ovarian-reserve/