Cyclophosphamide treatment for systemic sclerosis linked to lower ovarian reserve in women

NASHVILLE, Tenn. — In women with systemic sclerosis, cyclophosphamide therapy negatively correlated with ovarian reserve, according to a presenter at the CHEST Annual Meeting.

Regina Goloeva, PhD, of the V.A. Nasonova Research Institute of Rheumatology in Moscow, and colleagues evaluated 48 women aged 20 to 40 years (mean age, 32.9 years; range, 28-37) with systemic sclerosis (SSc) and 15 age-matched women without SSc to observe how anti-Mullerian hormone (AMH) levels correlated with disease severity and receipt of various therapeutic regimens.

In the patients with SSc, 41.7% had diffuse cutaneous disease, 41.7% had limited disease and 16.6% had overlap, according to the study abstract.

Of the total cohort, mean disease duration was 6.3 years (range, 3-10).

In SSc patients, researchers found the mean AMH level was 2.8 ng/mL, compared with 3.1 ng/mL among the control patients.

Researchers found that compared with the control women, a greater proportion of women with SSc had an AMH less than 1 ng/mL, which the researchers classified as reduced ovarian reserve (45.8% vs. 13%; P < .05).

Patients with diffuse SSc had significantly lower average AMH levels than those with limited SSc, and researchers more frequently observed decreased ovarian reserve in this subset (65% vs. 35%; P = .05). Mean AMH levels also appeared lower among those with acute and subacute SSc, with a greater proportion of those with subacute vs. chronic SSc having decreased ovarian reserve (68% vs. 24%; P = .03).

Researchers observed a mean AMH level of 1.86 ng/mL for patients with interstitial lung disease from SSc (SSc-ILD) compared with 2.87 ng/mL for those without ILD, with a comparable proportion of these groups having decreased ovarian reserve (50% vs. 33%).

Lastly, researchers found significantly reduced mean AMH levels among patients with SSc who were taking doses of cyclophosphamide. According to the abstract, AMH was negatively correlated with cyclophosphamide therapy (Pearson correlation coefficient [r] = –0.33; P < .05), erythrocyte sedimentation rate (r = –0.36), heart damage (r = –0.32), gastrointestinal tract involvement (r= –0.31) and digital ulcers (r = –0.33).

Researchers concluded that ovarian function was adversely altered by cyclophosphamide therapy “most likely in a dose-dependent manner.”

Reference:

Goloeva R, et al. Chest. 2022;doi:10.1016/j.chest.2022.08.1794.