The efficacy of hydroxychloroquine in altering pregnancy outcome in women with antiphospholipid antibodies

Savino Sciascia; D. Ware Branch; Roger A. Levy; Saskia Middeldorp; Sue Pavord; Dario Roccatello; Guillermo Ruiz-Irastorza; Angela Tincani; Munther Khamashta; Karen Schreiber; Beverley J. Hunt

doi:10.1160/th15-06-0491

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2016; 115(02): 285-290
DOI: 10.1160/th15-06-0491

Coagulation and Fibrinolysis

Schattauer GmbH

The efficacy of hydroxychloroquine in altering pregnancy outcome in women with antiphospholipid antibodies

Evidence and clinical judgment

Savino Sciascia

¹Thrombosis & Haemophilia Centre, St Thomas’ Hospital, London UK

²Centro di Ricerche di Immunopatologia e Documentazione su Malattie Rare (CMID), Struttura Complessa Direzione Universitaria di Immunologia Clinica, Università di Torino e Ospedale G Bosco, Torino, Italy

,

D. Ware Branch

³University of Utah and Intermountain Healthcare, Salt Lake City, Utah, USA

,

Roger A. Levy

⁴Discipline of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil

,

Saskia Middeldorp

⁵Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

,

Sue Pavord

⁶Department of Haematology, University Hospitals of Leicester, Leicester, UK

⁷Department of Haematology, Oxford University Hospitals, Oxford, UK

,

Dario Roccatello

²Centro di Ricerche di Immunopatologia e Documentazione su Malattie Rare (CMID), Struttura Complessa Direzione Universitaria di Immunologia Clinica, Università di Torino e Ospedale G Bosco, Torino, Italy

,

Guillermo Ruiz-Irastorza

⁸Autoimmune Diseases Research Unit, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, Spain

,

Angela Tincani

⁹Department of Clinical and Experimental Science, University of Brescia, Italy

,

Munther Khamashta

¹⁰Graham Hughes Lupus Research Laboratory, Division of Women’s Health King’s College London, The Rayne Institute, St Thomas’ Hospital, London, UK

,

Karen Schreiber

¹Thrombosis & Haemophilia Centre, St Thomas’ Hospital, London UK

¹¹Department of Rheumatology, Copenhagen University Hospital at Rigshospitalet, Denmark

,

Beverley J. Hunt

¹Thrombosis & Haemophilia Centre, St Thomas’ Hospital, London UK

› Institutsangaben

Abstract

Summary

The use of low-dose aspirin and heparinoids has improved the pregnancy outcome in obstetric antiphospholipid syndrome (APS). However, current treatment fails in 20–30 % of APS pregnancies, raising the need to explore other treatments to improve obstetrical outcome. Hydroxychloroquine (HCQ) is widely used in patients with autoimmune diseases, mainly systemic lupus erythematous (SLE), due to its anti-inflammatory, anti-aggregant and immune-regulatory properties. Evidence from in vitro and animal models suggests a potential protective effect of HCQ in obstetric APS. Pending the availability of prospective trials, we aimed to systematically review the available evidence and to assess the clinical judgment of a panel of experts regarding the use of HCQ in improving pregnancy outcome in women with anti-phospholipid antibodies (aPL). Clinical data on the ability of HCQ to improve pregnancy outcome in women with aPL are very limited in the available literature. Only one cohort study evaluating maternal and fetal outcome of pregnancy in patients with SLE who were exposed to HCQ was identified. Four of 14 (29 %) treated with HCQ patients had pregnancy failure, compared with six of 24 (25 %) of patients not treated with HCQ. However, the effect of HCQ was not adjusted for the use of other medications such as aspirin, heparins or steroids. Selected experts were contacted by e-mail and asked to review the summary of the evidence provided by the working group and to briefly answer each of the proposed questions. Overall, the panel of experts agreed that adding HCQ could be considered in selected cases or after failure of standard treatment with aspirin and a heparin agent. Specifically, the majority of experts considered adding HCQ in specific scenarios, such as women with previous thrombosis (either arterial and/or venous), and/or with previous ischaemic placenta-mediated complications. Prospective studies are necessary before the use of HCQ during pregnancy in women with aPL should be routinely recommended for clinical practice.

Keywords

Antiphospholipid antibodies - antiphospholipid syndrome - pregnancy

Volltext

Referenzen

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