Treatment of refractory poor aPL-related obstetric outcomes with TNF-alpha blockers : Maternal-fetal outcomes in a series of 18 cases
Copyright © 2019. Published by Elsevier Inc..
BACKGROUND: No absolute data on the treatment of antiphospholipid antibodies (aPL) related to refractory obstetric complications exist to date. TNF-α play a major role in this disorder.
OBJECTIVE: To assess the effectiveness of TNF-α blockers in 18 aPL-positive women with recurrent infertility after therapy with low-molecular-weight heparin (LMWH) plus aspirin (LDA) plus hydroxychloroquine (HCQ).
METHODS: Prospective case-series of 12 women fulfilling Sydney criteria for obstetric antiphospholipid syndrome (OAPS) and 6 with incomplete forms (OMAPS). All women tested positive for aPL at least twice. Non-criteria aPL were tested in 15/18. Complement, TNF-α and IL-10 were also evaluated. Women were closely monitored for fetal well-being and possible malformations throughout gestation and the postpartum period.
RESULTS: Sixteen patients were started on adalimumab and 2 on certolizumab. Twelve women completed gestation: 9 at term and 3 pre-term. Differences in laboratory categories and outcomes were observed when OAPS and OMAPS were compared. First trimester miscarriage or implantation failure recurred in 6 cases, all of the OAPS group. Malformations were not seen in the newborns.
CONCLUSIONS: Overall, good obstetric results were obtained in 70% of previous LMWH-LDA+HCQ refractory cases. TNF-α blockers were well tolerated without adverse effects. The combination of LMWH plus LDA plus TNF-α blockers appears to be a promising treatment for refractory obstetric complaints related to aPL; nevertheless, outcome differences between OAPS and OMAPS do exist.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:49 |
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| Enthalten in: |
Seminars in arthritis and rheumatism - 49(2019), 2 vom: 13. Okt., Seite 314-318 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Alijotas-Reig, Jaume [VerfasserIn] |
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| Links: |
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| Themen: |
Antibodies, Antiphospholipid |
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| Anmerkungen: |
Date Completed 30.06.2020 Date Revised 30.06.2020 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.semarthrit.2019.02.006 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM29448597X |
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| 245 | 1 | 0 | |a Treatment of refractory poor aPL-related obstetric outcomes with TNF-alpha blockers |b Maternal-fetal outcomes in a series of 18 cases |
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| 500 | |a Date Revised 30.06.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2019. Published by Elsevier Inc. | ||
| 520 | |a BACKGROUND: No absolute data on the treatment of antiphospholipid antibodies (aPL) related to refractory obstetric complications exist to date. TNF-α play a major role in this disorder | ||
| 520 | |a OBJECTIVE: To assess the effectiveness of TNF-α blockers in 18 aPL-positive women with recurrent infertility after therapy with low-molecular-weight heparin (LMWH) plus aspirin (LDA) plus hydroxychloroquine (HCQ) | ||
| 520 | |a METHODS: Prospective case-series of 12 women fulfilling Sydney criteria for obstetric antiphospholipid syndrome (OAPS) and 6 with incomplete forms (OMAPS). All women tested positive for aPL at least twice. Non-criteria aPL were tested in 15/18. Complement, TNF-α and IL-10 were also evaluated. Women were closely monitored for fetal well-being and possible malformations throughout gestation and the postpartum period | ||
| 520 | |a RESULTS: Sixteen patients were started on adalimumab and 2 on certolizumab. Twelve women completed gestation: 9 at term and 3 pre-term. Differences in laboratory categories and outcomes were observed when OAPS and OMAPS were compared. First trimester miscarriage or implantation failure recurred in 6 cases, all of the OAPS group. Malformations were not seen in the newborns | ||
| 520 | |a CONCLUSIONS: Overall, good obstetric results were obtained in 70% of previous LMWH-LDA+HCQ refractory cases. TNF-α blockers were well tolerated without adverse effects. The combination of LMWH plus LDA plus TNF-α blockers appears to be a promising treatment for refractory obstetric complaints related to aPL; nevertheless, outcome differences between OAPS and OMAPS do exist | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Antiphospholipid antibody | |
| 650 | 4 | |a Antiphospholipid syndrome | |
| 650 | 4 | |a Infertility | |
| 650 | 4 | |a TNF-α blockers | |
| 650 | 4 | |a Treatment | |
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| 700 | 1 | |a Llurba, Elisa |e verfasserin |4 aut | |
| 700 | 1 | |a Gris, Josep Mª |e verfasserin |4 aut | |
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