TY - JOUR
T1 - Effect of Additional Treatments Combined with Conventional Therapies in Pregnant Patients with High-Risk Antiphospholipid Syndrome
T2 - A Multicentre Study
AU - Ruffatti, Amelia
AU - Tonello, Marta
AU - Hoxha, Ariela
AU - Sciascia, Savino
AU - Cuadrado, Maria J.
AU - Latino, José O.
AU - Udry, Sebastian
AU - Reshetnyak, Tatiana
AU - Costedoat-Chalumeau, Nathalie
AU - Morel, Nathalie
AU - Marozio, Luca
AU - Tincani, Angela
AU - Andreoli, Laura
AU - Haladyj, Ewa
AU - Meroni, Pier L.
AU - Gerosa, Maria
AU - Alijotas-Reig, Jaume
AU - Tenti, Sara
AU - Mayer-Pickel, Karoline
AU - Simchen, Michal J.
AU - Bertero, Maria T.
AU - De Carolis, Sara
AU - Ramoni, Véronique
AU - Mekinian, Arsène
AU - Grandone, Elvira
AU - Maina, Aldo
AU - Serrano, Fátima
AU - Pengo, Vittorio
AU - Khamashta, Munther A.
N1 - Publisher Copyright:
© 2018 Schattauer.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - The effect of additional treatments combined with conventional therapy on pregnancy outcomes was examined in high-risk primary antiphospholipid syndrome (PAPS) patients to identify the most effective treatment strategy. The study's inclusion criteria were (1) positivity to lupus anticoagulant alone or associated with anticardiolipin and/or anti-β2 glycoprotein I antibodies; (2) a history of severe maternal-foetal complications (Group I) or a history of one or more pregnancies refractory to conventional therapy leading to unexplained foetal deaths not associated with severe maternal-foetal complications (Group II). Two different additional treatments were considered: oral--low-dose steroids (10-20 mg prednisone daily) and/or 200 to 400 mg daily doses of hydroxychloroquine and parenteral--intravenous immunoglobulins at 2 g/kg per month and/or plasma exchange. The study's primary outcomes were live birth rates and pregnancy complications. A total of 194 pregnant PAPS patients attending 20 tertiary centres were retrospectively enrolled. Hydroxychloroquine was found to be linked to a significantly higher live birth rate with respect to the other oral treatments in the Group II patients. The high (400 mg) versus low (200 mg) doses of hydroxychloroquine (p = 0.036) and its administration before versus during pregnancy (p = 0.021) were associated with a significantly higher live birth rate. Hydroxychloroquine therapy appeared particularly efficacious in the PAPS patients without previous thrombosis. Parenteral treatments were associated with a significantly higher live birth rate with respect to the oral ones (p = 0.037), particularly in the Group I patients. In conclusion, some additional treatments were found to be safe and efficacious in high-risk PAPS pregnant women.
AB - The effect of additional treatments combined with conventional therapy on pregnancy outcomes was examined in high-risk primary antiphospholipid syndrome (PAPS) patients to identify the most effective treatment strategy. The study's inclusion criteria were (1) positivity to lupus anticoagulant alone or associated with anticardiolipin and/or anti-β2 glycoprotein I antibodies; (2) a history of severe maternal-foetal complications (Group I) or a history of one or more pregnancies refractory to conventional therapy leading to unexplained foetal deaths not associated with severe maternal-foetal complications (Group II). Two different additional treatments were considered: oral--low-dose steroids (10-20 mg prednisone daily) and/or 200 to 400 mg daily doses of hydroxychloroquine and parenteral--intravenous immunoglobulins at 2 g/kg per month and/or plasma exchange. The study's primary outcomes were live birth rates and pregnancy complications. A total of 194 pregnant PAPS patients attending 20 tertiary centres were retrospectively enrolled. Hydroxychloroquine was found to be linked to a significantly higher live birth rate with respect to the other oral treatments in the Group II patients. The high (400 mg) versus low (200 mg) doses of hydroxychloroquine (p = 0.036) and its administration before versus during pregnancy (p = 0.021) were associated with a significantly higher live birth rate. Hydroxychloroquine therapy appeared particularly efficacious in the PAPS patients without previous thrombosis. Parenteral treatments were associated with a significantly higher live birth rate with respect to the oral ones (p = 0.037), particularly in the Group I patients. In conclusion, some additional treatments were found to be safe and efficacious in high-risk PAPS pregnant women.
KW - antiphospholipid syndrome
KW - hydroxychloroquine
KW - intravenous immunoglobulins
KW - low-dose steroids
KW - plasma exchange
UR - http://www.scopus.com/inward/record.url?scp=85042793183&partnerID=8YFLogxK
U2 - 10.1055/s-0038-1632388
DO - 10.1055/s-0038-1632388
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 29490410
AN - SCOPUS:85042793183
SN - 0340-6245
VL - 118
SP - 639
EP - 646
JO - Thrombosis and Haemostasis
JF - Thrombosis and Haemostasis
IS - 4
ER -