Anti-mullerian hormone and ovarian reserve in systemic lupus erythematosus.

Department of Medicine, Tuen Mun Hospital, Hong Kong, China. .
Arthritis & Rheumatology (Impact Factor: 7.87). 10/2012; DOI: 10.1002/art.37719
Source: PubMed

ABSTRACT OBJECTIVES: 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). METHOD: Consecutive female patients aged 18-52 years who had menstruation in the preceding 12 months and fulfilled ?4 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 and receiver operating characteristic (ROC) curve analysis. RESULTS: 216 patients were studied (age 35.1?10.1 years, SLE duration 7.6?5.9 years). AMH level was significantly lower in patients with previous CYC exposure than those without, adjusted for age (1.58?2.92 vs 1.73?2.11 ng/mL; p=0.04). The median time interval between AMH assay and last dose of CYC administered was 6.7 years (inter-quartile range 3.4-8.5). AMH levels were not statistically different between users and non-users of other immunosuppressive agents that included mycophenolate mofetil, azathioprine and the calcineurin inhibitors. Linear regression revealed increasing 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. In patients aged ?30 years, a cumulative CYC dose cut-off of 5.9g yielded a sensitivity of 0.75 and a specificity of 0.80 for the prediction of undetectable AMH level on ROC curve analysis. CONCLUSION: AMH is a sensitive marker for ovarian damage due to previous CYC exposure in SLE patients. © 2012 American College of Rheumatology.

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