Refractory obstetrical antiphospholipid syndrome : Features, treatment and outcome in a European multicenter retrospective study
Copyright © 2017 Elsevier B.V. All rights reserved..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:16 |
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| Enthalten in: |
Autoimmunity reviews - 16(2017), 7 vom: 20. Juli, Seite 730-734 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mekinian, Arsène [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 29.11.2017 Date Revised 02.12.2018 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.autrev.2017.05.006 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM271634480 |
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| 245 | 1 | 0 | |a Refractory obstetrical antiphospholipid syndrome |b Features, treatment and outcome in a European multicenter retrospective study |
| 264 | 1 | |c 2017 | |
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| 500 | |a Date Completed 29.11.2017 | ||
| 500 | |a Date Revised 02.12.2018 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2017 Elsevier B.V. All rights reserved. | ||
| 520 | |a AIM: To describe the consecutive pregnancy outcome and treatment in refractory obstetrical antiphospholipid syndrome (APS) | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Antiphospholipid antibodies | |
| 650 | 4 | |a Hydroxychloroquine | |
| 650 | 4 | |a Outcome | |
| 650 | 4 | |a Refractory obstetrical APS | |
| 650 | 4 | |a Treatment | |
| 650 | 7 | |a Antibodies, Antiphospholipid |2 NLM | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 650 | 7 | |a Heparin, Low-Molecular-Weight |2 NLM | |
| 650 | 7 | |a Lupus Coagulation Inhibitor |2 NLM | |
| 650 | 7 | |a Aspirin |2 NLM | |
| 650 | 7 | |a R16CO5Y76E |2 NLM | |
| 700 | 1 | |a Alijotas-Reig, Jaume |e verfasserin |4 aut | |
| 700 | 1 | |a Carrat, Fabrice |e verfasserin |4 aut | |
| 700 | 1 | |a Costedoat-Chalumeau, Nathalie |e verfasserin |4 aut | |
| 700 | 1 | |a Ruffatti, Amelia |e verfasserin |4 aut | |
| 700 | 1 | |a Lazzaroni, Maria Grazia |e verfasserin |4 aut | |
| 700 | 1 | |a Tabacco, Sara |e verfasserin |4 aut | |
| 700 | 1 | |a Maina, Aldo |e verfasserin |4 aut | |
| 700 | 1 | |a Masseau, Agathe |e verfasserin |4 aut | |
| 700 | 1 | |a Morel, Nathalie |e verfasserin |4 aut | |
| 700 | 1 | |a Esteve-Valverde, Enrique Esteve |e verfasserin |4 aut | |
| 700 | 1 | |a Ferrer-Oliveras, Raquel |e verfasserin |4 aut | |
| 700 | 1 | |a Andreoli, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a De Carolis, Sara |e verfasserin |4 aut | |
| 700 | 1 | |a Josselin-Mahr, Laurence |e verfasserin |4 aut | |
| 700 | 1 | |a Abisror, Noémie |e verfasserin |4 aut | |
| 700 | 1 | |a Nicaise-Roland, Pascale |e verfasserin |4 aut | |
| 700 | 1 | |a Tincani, Angela |e verfasserin |4 aut | |
| 700 | 1 | |a Fain, Olivier |e verfasserin |4 aut | |
| 700 | 0 | |a on the behalf of the SNFMI and the European Forum on Antiphospholipid Antibodies |e verfasserin |4 aut | |
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