TY - JOUR
T1 - Refractory obstetrical antiphospholipid syndrome: Features, treatment and outcome in a European multicenter retrospective study
AU - Mekinian, Arsène
AU - Alijotas-Reig, Jaume
AU - Carrat, Fabrice
AU - Costedoat-Chalumeau, Nathalie
AU - Ruffatti, Amelia
AU - Lazzaroni, Maria Grazia
AU - Tabacco, Sara
AU - Maina, Aldo
AU - Masseau, Agathe
AU - Morel, Nathalie
AU - Ferrer-Oliveras, Raquel
AU - Andreoli, Laura
AU - De Carolis, Sara
AU - Josselin-Mahr, Laurence
AU - Abisror, Noémie
AU - Nicaise-Roland, Pascale
AU - Tincani, Angela
AU - Fain, Olivier
AU - Esteve Valverde, Enrique
PY - 2017/7/1
Y1 - 2017/7/1
N2 - © 2017 Elsevier B.V. Aim To describe the consecutive pregnancy outcome and treatment in refractory obstetrical antiphospholipid syndrome (APS). Methods Retrospective multicenter open-labelled study from December 2015 to June 2016. We analyzed the outcome of pregnancies in patients with obstetrical APS (Sydney criteria) and previous adverse obstetrical event despite low-dose aspirin and low-molecular weight heparin LMWH (LMWH) conventional treatment who experienced at least one subsequent pregnancy. Results Forty nine patients with median age 27 years (23 − 32) were included from 8 European centers. Obstetrical APS was present in 71%, while 26% had obstetrical and thrombotic APS. Lupus anticoagulant was present in 76% and triple antiphospholipid antibody (APL) positivity in 45% of patients. Pregnancy loss was noted in 71% with a median age of gestation of 11 (8–21) weeks. The presence of APS non-criteria features (35% vs 17% in pregnancies without adverse obstetrical event; p = 0.09), previous intrauterine death (65% vs 38%; p = 0.06), of LA (90% vs 65%; p = 0.05) were more frequent in pregnancies with adverse pregnancy outcome, whereas isolated recurrent miscarriage profile was more frequent in pregnancies without any adverse pregnancy outcome (15% vs 41%; p = 0.04). In univariate analysis considering all pregnancies (index and subsequent ones), an history of previous intrauterine death was associated with pregnancy loss (odds-ratio 2.51 (95% CI 1.274.96); p = 0.008), whereas previous history of prematurity related to APS (odds-ratio 0.13 95%CI 0.04 0.41, P = 0.006), steroids use during the pregnancy (odds-ratio 0.30 95% CI 0.11–0.82, p = 0.019) and anticardiolipids isolated profile (odds-ratio 0.51 95% CI 0.26–1.03, p = 0.0588) were associated with favorable outcome. In multivariate analysis, only previous history of prematurity, steroids use and anticardiolipids isolated profiles were associated with live-birth pregnancy. Conclusion The main features of refractory obstetrical APS were the high rates of LA and triple APL positivity. Steroids could be effective in this APS profile, but prospective studies are necessary.
AB - © 2017 Elsevier B.V. Aim To describe the consecutive pregnancy outcome and treatment in refractory obstetrical antiphospholipid syndrome (APS). Methods Retrospective multicenter open-labelled study from December 2015 to June 2016. We analyzed the outcome of pregnancies in patients with obstetrical APS (Sydney criteria) and previous adverse obstetrical event despite low-dose aspirin and low-molecular weight heparin LMWH (LMWH) conventional treatment who experienced at least one subsequent pregnancy. Results Forty nine patients with median age 27 years (23 − 32) were included from 8 European centers. Obstetrical APS was present in 71%, while 26% had obstetrical and thrombotic APS. Lupus anticoagulant was present in 76% and triple antiphospholipid antibody (APL) positivity in 45% of patients. Pregnancy loss was noted in 71% with a median age of gestation of 11 (8–21) weeks. The presence of APS non-criteria features (35% vs 17% in pregnancies without adverse obstetrical event; p = 0.09), previous intrauterine death (65% vs 38%; p = 0.06), of LA (90% vs 65%; p = 0.05) were more frequent in pregnancies with adverse pregnancy outcome, whereas isolated recurrent miscarriage profile was more frequent in pregnancies without any adverse pregnancy outcome (15% vs 41%; p = 0.04). In univariate analysis considering all pregnancies (index and subsequent ones), an history of previous intrauterine death was associated with pregnancy loss (odds-ratio 2.51 (95% CI 1.274.96); p = 0.008), whereas previous history of prematurity related to APS (odds-ratio 0.13 95%CI 0.04 0.41, P = 0.006), steroids use during the pregnancy (odds-ratio 0.30 95% CI 0.11–0.82, p = 0.019) and anticardiolipids isolated profile (odds-ratio 0.51 95% CI 0.26–1.03, p = 0.0588) were associated with favorable outcome. In multivariate analysis, only previous history of prematurity, steroids use and anticardiolipids isolated profiles were associated with live-birth pregnancy. Conclusion The main features of refractory obstetrical APS were the high rates of LA and triple APL positivity. Steroids could be effective in this APS profile, but prospective studies are necessary.
KW - Antiphospholipid antibodies
KW - Hydroxychloroquine
KW - Outcome
KW - Refractory obstetrical APS
KW - Treatment
U2 - 10.1016/j.autrev.2017.05.006
DO - 10.1016/j.autrev.2017.05.006
M3 - Review article
SN - 1568-9972
VL - 16
SP - 730
EP - 734
JO - Autoimmunity Reviews
JF - Autoimmunity Reviews
IS - 7
ER -