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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ACR Meeting Abstracts - https://acrabstracts.org/abstract/study-of-anti-mullerian-hormone-and-probability-of-pregnancy-in-112-systemic-lupus-erythematosus-patients-exposed-or-not-to-cyclophosphamide/