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Abstract Number: 641

Study of Anti-Müllerian Hormone and Probability of Pregnancy in 112 Systemic Lupus Erythematosus Patients Exposed or Not to Cyclophosphamide

Nathalie Morel1, Anne Bachelot2, Zeina Chakhtoura2, Zahir Amoura1, Olivier Aumaitre3, Jean-Emmanuel Kahn4, Du Boutin5, Pierre Duhaut6, Dominique Farge7, Camille Francès1, Lionel Galicier8, Gaëlle Guettrot-Imbert3, Jean-Robert Harlé9, Olivier Lambotte10, Véronique Le Guern11, Jean-Charles Piette12, Jacques Pourrat13, Karim Sacre14, Damien Sene15, Salim Trad16, Elisabeth Vidal17, Lamiae Grimaldi18, Christiane Coussieu19, Nathalie Costedoat-Chalumeau20 and PLUS21, 1Internal Medicine, Groupe Hospitalier Pitié-Salpétrière, Paris, France, 2Endocrinology, Groupe Hospitalier Pitié-Salpétrière, Paris, France, 3Internal Medicine, Centre Hospitalier de Clermont-Ferrand, Clermont-Ferrand, France, 4Internal Medicine, Foch Hospital, Suresnes, France, 5Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hopital Pitié-Salpétrière, Paris, France, 6Internal Medicine and RECIF, CHU Nord, Amiens, France, 7Medicine, EBMT, Paris, France, 8Internal Medicine, Hopital Saint Louis, Paris, France, 9Internal Medicine, CHU Toulouse, Toulouse, France, 10Internal Medicine, Hopital Kremlin Bicêtre, Kremlin Bicêtre, France, 11Department of Internal Medicine, Cochin Hospital, Paris, France, 12Internal Medicine 2, Groupe Hospitalier Pitié-Salpétrière, Paris, France, 13Toulouse University Hospital, University of Toulouse, Toulouse, France, 14Internal Medicine, University Paris-7, INSERM U699, APHP, Bichat Hospital, Paris, France, 15Internal Medicine, Hopital Lariboisière, Paris, France, 16Internal Medicine, Hopital Ambroise Paré, Paris, France, 17Department of Internal Medicine A, Dupuytren Hospital, Limoges University Hospital, Limoges, France, 18Société Laser, Paris, France, 19Groupe Hospitalier Pitié-Salpétrière, Paris, France, 20Internal Medicine, Hopital Cochin, Paris, France, 21Paris, France

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Fertility, hormones, systemic lupus erythematosus (SLE) and treatment

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Session Information

Session Title: Systemic Lupus Erythematosus: Clinical Aspects

Session Type: Abstract Submissions (ACR)

Background/Purpose: Cyclophosphamide (CYC), a drug commonly used in systemic lupus erythematosus (SLE), is associated with a risk of ovarian failure resulting in infertility. In the general population, anti-Müllerian hormone (AMH) level is correlated with ovarian reserve in adult women. We compared AMH serum levels in SLE patients with and without previous cyclophosphamide treatment (exposed and unexposed group). For the first time, we analyzed their subsequent probability of pregnancy.

Methods: This ancillary study was done on serum bank collected during the PLUS study between 07/2007 and 11/2009 (ClinicalTrials.gov: NCT00413361). SLE women included in the PLUS study, below 40 years and who had been exposed to CYC were compared to SLE patients unexposed to CYC and matched for age at 6 months. AMH concentration was determined by Elisa using Immunotech kit (Beckman-Coulter). All patients were contacted by phone in May 2012, and provided information regarding their pregnancies following the date of sample.

Results: 112 patients (56 exposed and 56 not exposed patients) were included. Mean age was 31.6 ± 5.8 years.

The mean AMH serum level was 1.21 ± 1.01 ng/ml. 82% of the patients had AMH < 2 ng/ml and 50 % had AMH ≤1 ng/ml. The mean AMH serum level was significantly lower in patients exposed to CYC than in unexposed (1.02 ± 0.97 vs 1.41 ± 1.01 ng/ml, p = 0.03) and in patients older than 30 years-old (1.02 ± 0.97 versus 1.43 ± 1.02 ng/ml, p = 0.02).

Mean follow-up (interval between sample and phone interview) was 3.9 ± 0.6 years. During this follow-up, 36 of the 112 patients willed to become pregnant, and 30 succeed (83.3%). In univariate analysis, the risk of failure was associated with exposure to CYC (5 failure in 15 versus 1 failure in 21, p=0.023), older age (35.5 ± 4.8 years old at sample in failure versus 30 ± 4.3 years old in success, p = 0.024) and lower AMH serum level (0.64 ± 0.68 ng/ml in failure versus 1.6 ± 1.15 ng/ml in success, p=0.052).

Interestingly, pregnancy occurred in 6 out of 10 women who had very low AMH serum level (≤ 0.05 ng/ml), and in 10 out of 14 who had AMH serum level ≤ 1 ng/ml.

Conclusion: As previously reported, we confirm that the AMH level is low in many SLE patients, and that this level decreases significantly with age and with exposition to CYC. However, and despite this, we show for the first time that the risk of failure to become pregnant was low with pregnancy obtained in 83.3% of the patients who were willing to become pregnant. Successes were observed even in the patients with the lowest level of AMH. Preliminary results show that  failure was associated with older age and CYC exposition. Additional analyses (multivariate analyses) are ongoing.


Disclosure:

N. Morel,
None;

A. Bachelot,
None;

Z. Chakhtoura,
None;

Z. Amoura,
None;

O. Aumaitre,
None;

J. E. Kahn,
None;

D. Boutin,
None;

P. Duhaut,
None;

D. Farge,
None;

C. Francès,
None;

L. Galicier,
None;

G. Guettrot-Imbert,
None;

J. R. Harlé,
None;

O. Lambotte,
None;

V. Le Guern,
None;

J. C. Piette,
None;

J. Pourrat,
None;

K. Sacre,
None;

D. Sene,
None;

S. Trad,
None;

E. Vidal,
None;

L. Grimaldi,
None;

C. Coussieu,
None;

N. Costedoat-Chalumeau,
None;

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