Arsène Mekinian1, Jaume Alijotas-Reig2, Fabrice Carrat3, Nathalie Costedoat-Chalumeau4, Amelia Ruffatti5, Maria Grazia Lazzaroni6, Sara Tabacco7, Aldo Maina8, Agathe Masseau9, Nathalie Morel10, Enrique Esteve Esteve-Valverde2, Raquel Ferrer-Oliveras2, Laura Andreoli6, Sara De Carolis11, Laurence Josselin-Mahr12, Noémie Abisror12, Pascale Nicaise-Roland13, Angela Tincani6, Olivier Fain12. 1. AP-HP, Hôpital Saint-Antoine, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC University Paris 06, F-75012 Paris, France. Electronic address: arsene.mekinian@aphp.fr. 2. Systemic Autoimmune Disease Unit, Department of Internal Medicine I, Vall d'Hebrón University Hospital, Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain. 3. AP-HP, Hôpital Saint-Antoine, service de Biostatistiques, Sorbonne Universités, UPMC Univ Paris 06, F-75012 Paris, France. 4. Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne Pôle médecine, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint Jacques, 75679 Paris cedex 14, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France. 5. Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy. 6. Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University and Spedali Civili of Brescia, Brescia, Italy. 7. Department of Gynaecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy. 8. Department of Internal Medicine, Ospedale Sant'Anna, Torino, Italy. 9. Hôpital Hôtel Dieu, service de médecine interne, Université de Nantes, Nantes, France. 10. AP-HP, Cochin Hospital, Internal Medicine Department, Paris, France; Université Paris 7, Paris, France. 11. Department of Obstetrics and Gynaecology, Catholic University of Sacred Heart, Rome, Italy. 12. AP-HP, Hôpital Saint-Antoine, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC University Paris 06, F-75012 Paris, France. 13. AP-HP, Unité Fonctionnelles d'Immunologie "Auto-immunité et Hypersensibilités", Hôpital Bichat-Claude Bernard, Paris, France.
Abstract
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 27years (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.
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 heparinLMWH (LMWH) conventional treatment who experienced at least one subsequent pregnancy. RESULTS: Forty nine patients with median age 27years (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.
Authors: Manuela Velásquez; Luisa F Peláez; Mauricio Rojas; Raúl Narváez-Sánchez; Jesús A Velásquez; Carlos Escudero; Sebastián San Martín; Ángela P Cadavid Journal: Front Physiol Date: 2021-12-02 Impact factor: 4.566
Authors: Ilan Volkov; Luciana Seguro; Elaine P Leon; László Kovács; Dirk Roggenbuck; Peter Schierack; Boris Gilburd; Andrea Doria; Maria G Tektonidou; Nancy Agmon-Levin Journal: Auto Immun Highlights Date: 2020-05-15