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.

Ruffatti, A., Tonello, M., Hoxha, A., Sciascia, S., Cuadrado, M. J., Latino, J. O., Udry, S., Reshetnyak, T., Costedoat-Chalumeau, N., Morel, N., Marozio, L., Tincani, A., Andreoli, L., Haladyj, E., Meroni, P. L., Gerosa, M., Alijotas-Reig, J., Tenti, S., Mayer-Pickel, K., Simchen, M. J., Bertero, M. T., De Carolis, S., Ramoni, V., Mekinian, A., Grandone, E., Maina, A., Serrano, F., Pengo, V., Khamashta, M. A., Effect of Additional Treatments Combined with Conventional Therapies in Pregnant Patients with High-Risk Antiphospholipid Syndrome: A Multicentre Study, <<THROMBOSIS AND HAEMOSTASIS>>, 2018; 118 (4): 639-646. [doi:10.1055/s-0038-1632388] [http://hdl.handle.net/10807/132673]

Effect of Additional Treatments Combined with Conventional Therapies in Pregnant Patients with High-Risk Antiphospholipid Syndrome: A Multicentre Study

De Carolis, Sara;
2018

Abstract

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.
2018
Inglese
Ruffatti, A., Tonello, M., Hoxha, A., Sciascia, S., Cuadrado, M. J., Latino, J. O., Udry, S., Reshetnyak, T., Costedoat-Chalumeau, N., Morel, N., Marozio, L., Tincani, A., Andreoli, L., Haladyj, E., Meroni, P. L., Gerosa, M., Alijotas-Reig, J., Tenti, S., Mayer-Pickel, K., Simchen, M. J., Bertero, M. T., De Carolis, S., Ramoni, V., Mekinian, A., Grandone, E., Maina, A., Serrano, F., Pengo, V., Khamashta, M. A., Effect of Additional Treatments Combined with Conventional Therapies in Pregnant Patients with High-Risk Antiphospholipid Syndrome: A Multicentre Study, <<THROMBOSIS AND HAEMOSTASIS>>, 2018; 118 (4): 639-646. [doi:10.1055/s-0038-1632388] [http://hdl.handle.net/10807/132673]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/132673
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