14th International Congress on Antiphospholipid Antibodies: task force report on antiphospholipid syndrome treatment trends.
Antiphospholipid Syndrome (APS) is characterized by vascular thrombosis and/or pregnancy morbidity occurring in patients with persistent antiphospholipid antibodies (aPL). The primary objective of the APS Treatment Trends Task Force, created as part of the 14th International Congress on aPL, was to systematically review the potential future treatment strategies for aPL-positive patients. The task force chose as future clinical research directions: a) determining the necessity for controlled clinical trials in venous thromboembolism with the new oral direct thrombin or anti-factor Xa inhibitors pending the results of the ongoing rivaroxaban in APS (RAPS) trial, and designing controlled clinical trials in other forms of thrombotic APS; b) systematically analyzing the literature as well as aPL/APS registries, and creating specific registries for non-warfarin/heparin anticoagulants; c) increasing recruitment for an ongoing primary thrombosis prevention trial, and designing secondary thrombosis and pregnancy morbidity prevention trials with hydroxychloroquine; d) determining surrogate markers to select patients for statin trials; e) designing controlled studies with rituximab and other anti-B-cell agents; f) designing mechanistic and clinical studies with eculizumab and other complement inhibitors; and g) chemically modifying peptide therapy to improve the half-life and minimize immunogenicity. The report also includes recommendations for clinicians who consider using these agents in difficult-to-manage aPL-positive patients.
Hospital For Special Surgery, Weill Cornell Medical College, New York, NY, USA. Electronic address: erkand@hss.edu.
Doruk
D
Erkan
Hospital For Special Surgery, Weill Cornell Medical College, New York, NY, USA.
Cassyanne L
CL
Aguiar
Department of Rheumatology, University of São Paulo School of Medicine, São Paulo, Brazil.
Danieli
D
Andrade
Department of Hematology, University College London Hospitals NHS Foundation Trust and University College London, London UK.
Hannah
H
Cohen
Lupus Unit, Guys' and St Thomas Foundation Trust, London, UK.
Maria J
MJ
Cuadrado
Department of Rheumatology, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.
Adriana
A
Danowski
Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Roger A
RA
Levy
Hemostasis and Thrombosis Center, Duke University Medical Center, Durham, NC, USA.
Thomas L
TL
Ortel
Department of Hematology, University College London Hospitals NHS Foundation Trust and University College London, London UK.
Anisur
A
Rahman
Hospital For Special Surgery, Weill Cornell Medical College, New York, NY, USA.
Jane E
JE
Salmon
First Department of Medicine, University of Athens School of Medicine, Athens, Greece.
Maria G
MG
Tektonidou
Division of Rheumatology,University of Texas Medical Branch, Galveston, TX, USA.
Rohan
R
Willis
Hospital For Special Surgery, Weill Cornell Medical College, New York, NY, USA.
Michael D
MD
Lockshin
D017152:Antibodies, Antiphospholipid / Q000276:immunology* / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*; D015951:Factor Xa / Q000276:immunology; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control
D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D006886:Hydroxychloroquine; D015951:Factor Xa
Antiphospholipid syndrome; Complement and B-cell inhibition; Hydroxychloroquine; Oral direct thrombin inhibitors; Peptide therapy; Statins