Anti-mullerian hormone and ovarian reserve in systemic lupus erythematosus

Objective To study the level of antimullerian hormone (AMH) and its relationship to age and previous exposure to cyclophosphamide (CYC) in patients with systemic lupus erythematosus (SLE). Methods Consecutive female patients ages 1852 years who had menses at least once during the preceding 12 months and fulfilled =4 American College of Rheumatology criteria for SLE were recruited. AMH was determined using an enzyme-linked immunosorbent assay (ELISA) kit. Serum AMH levels were compared in patients with and without previous use of immunosuppressive agents. The relationship of the AMH level to the patient's age and CYC exposure was studied by linear regression and receiver operating characteristic (ROC) curve analysis. Results A total of 216 patients were studied (mean +/- SD age 35.1 +/- 10.1 years, mean +/- SD SLE duration 7.6 +/- 5.9 years). The mean +/- SD AMH level was significantly lower in patients previously exposed to CYC therapy than in those who had not been exposed after adjustment for age (1.58 +/- 2.92 versus 1.73 +/- 2.11 ng/ml; P = 0.04). The median time interval between the AMH assay and the last dose of CYC administered was 6.7 years (interquartile range 3.48.5). AMH levels in users versus nonusers of other immunosuppressive agents, including mycophenolate mofetil, azathioprine, and the calcineurin inhibitors, were not statistically different. Linear regression revealed increasing age (beta -0.32, P = 0.02) and each 5 gm of CYC exposure (beta -0.28, P = 0.047) were independently associated with a lower AMH level. In patients ages 30 years and younger, a cumulative CYC dose cutoff of 5.9 gm 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 women with SLE.