Anti‐Müllerian hormone: A better marker of ovarian damage from cyclophosphamide

Clowse, Megan E.B.; Harward, Lindsey; Criscione-Schreiber, Lisa G; Pisetsky, David S.; Copland, Susannah D.

doi:10.1002/art.34431

Cited by 16 publications

(11 citation statements)

References 26 publications

(40 reference statements)

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“…Serum AMH levels in early RA are neither influenced by parameters of disease activity nor by use of MTX. This study hereby provides an answer to Clowse et al, who suggest AMH as a marker to detect subclinical damage to the ovary during and after cyclophosphamide therapy, but also point out that the impact of rheumatic disease and antirheumatic drugs on AMH expression is unknown ().…”

Section: Discussionmentioning

confidence: 52%

Levels of Serum Anti–Müllerian Hormone, a Marker for Ovarian Reserve, in Women With Rheumatoid Arthritis

Brouwer

Laven

Hazes

et al. 2013

Arthritis Care & Research

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Objective. Fertility is reduced in women with rheumatoid arthritis (RA), even before diagnosis. This may be due to a diminished ovarian reserve. The current study examined serum levels of anti-Mü llerian hormone (AMH), the most reliable endocrine marker for ovarian reserve, in early RA patients and the influence of disease activity and methotrexate (MTX) use on AMH concentrations. Methods. Serum AMH levels were measured in 72 women with recent-onset RA ages 18 -42 years and compared to 509 healthy women. The association between AMH and rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), erosions, C-reactive protein (CRP) level, disease activity (Disease Activity Score in 28 joints [DAS28]), and use of MTX was assessed. Results. At diagnosis, age-adjusted serum AMH levels did not differ significantly between patients and controls (P ‫؍‬ 0.254). AMH levels were not related to the presence of RF (P ‫؍‬ 0.487), anti-CCP (P ‫؍‬ 0.686), or erosions (P ‫؍‬ 0.350), and showed no significant correlation with CRP levels (r ‫؍‬ ؊0.207, P ‫؍‬ 0.083) or disease activity scores (DAS28; r ‫؍‬ 0.007, P ‫؍‬ 0.955). After 6 months of treatment, AMH levels in patients (n ‫؍‬ 53) were lower than at the time of diagnosis (P < 0.001), but did not differ from controls (P ‫؍‬ 0.741). There was no significant difference in AMH values after 6 months of treatment between patients who did (n ‫؍‬ 31) or did not (n ‫؍‬ 22) receive MTX (P ‫؍‬ 0.287). Conclusion. AMH levels in women with early RA are comparable to those of healthy controls, indicating that the reduced fertility in this patient group is not caused by diminished ovarian reserve. AMH levels are not affected either by disease activity or by short-term MTX use.

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Section: Discussionmentioning

confidence: 52%

Levels of Serum Anti–Müllerian Hormone, a Marker for Ovarian Reserve, in Women With Rheumatoid Arthritis

Brouwer

Laven

Hazes

et al. 2013

Arthritis Care & Research

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“…Anti–müllerian hormone (AMH) is expressed by the granulosa cells of growing follicles from the stage of primordial follicles to the FSH‐dependent phase of antral follicles (5). The AMH level is a surrogate marker that correlates with the pool of ovarian follicles leaving the primordial stage.…”

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confidence: 99%

Anti–müllerian hormone and ovarian reserve in systemic lupus erythematosus

Mok¹,

Chan²,

To³

2012

Arthritis & Rheumatism

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Objective.To study the level of anti-müllerian 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 18-52 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 3.4-8.5). 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.

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“…In this respect, AMH testing has opened a new avenue for understanding, because serum titers of this hormone, produced by the granulosa of the small growing antral ovarian follicles, correlate with follicle counts as determined by ultrasonography, which is still the gold standard for assessing the ovarian reserve . AMH is therefore considered a good marker of CYC‐induced ovarian damage in women with rheumatic diseases .…”

Section: Discussionmentioning

confidence: 99%