Refractory obstetrical antiphospholipid syndrome: Features, treatment and outcome in a European multicentre retrospective study

Publication date: Available online 4 May 2017
Source:Autoimmunity Reviews
Author(s): Arsène Mekinian, Jaume Alijotas-Reig, Fabrice Carrat, Nathalie Costedoat-Chalumeau, Amelia Ruffatti, Maria Grazia Lazzaroni, Sara Tabacco, Aldo Maina, Agathe Masseau, Nathalie Morel, Enrique Esteve Esteve-Valverde, Raquel Ferrer-Oliveras, Laura Andreoli, Sara De Carolis, Laurence Josselin-Mahr, Noémie Abisror, Pascale Nicaise-Roland, Angela Tincani, Olivier Fain
AimTo describe the consecutive pregnancy outcome and treatment in refractory obstetrical antiphospholipid syndrome (APS).MethodsRetrospective multicentre 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.ResultsForty 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 1.27–4.96); 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.ConclusionThe 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.



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