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.
Effect of Additional Treatments Combined with Conventional Therapies in Pregnant Patients with High-Risk Antiphospholipid Syndrome: A Multicentre Study / A. Ruffatti, M. Tonello, A. Hoxha, S. Sciascia, M.J. Cuadrado, J.O. Latino, S. Udry, T. Reshetnyak, N. Costedoat-Chalumeau, N. Morel, L. Marozio, A. Tincani, L. Andreoli, E. Haladyj, P.L. Meroni, M. Gerosa, J. Alijotas-Reig, S. Tenti, K. Mayer-Pickel, M.J. Simchen, M.T. Bertero, S. De Carolis, V. Ramoni, A. Mekinian, E. Grandone, A. Maina, F. Serrano, V. Pengo, M.A. Khamashta. - In: THROMBOSIS AND HAEMOSTASIS. - ISSN 0340-6245. - 118:4(2018 Apr), pp. 639-646.
|Titolo:||Effect of Additional Treatments Combined with Conventional Therapies in Pregnant Patients with High-Risk Antiphospholipid Syndrome: A Multicentre Study|
|Parole Chiave:||antiphospholipid syndrome; hydroxychloroquine; low-dose steroids; intravenous immunoglobulins; plasma exchange|
|Settore Scientifico Disciplinare:||Settore MED/40 - Ginecologia e Ostetricia|
Settore MED/16 - Reumatologia
Settore MED/15 - Malattie del Sangue
|Data di pubblicazione:||apr-2018|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1055/s-0038-1632388|
|Appare nelle tipologie:||01 - Articolo su periodico|