title: Obstetrical APS: is there a place for hydroxychloroquine to improve the pregnancy outcome?
abstract: The use of the conventional APS treatment (the combination of low-dose aspirin and LMWH) dramatically improved the obstetrical prognosis in primary obstetrical APS (OAPS). The persistence of adverse pregnancy outcome raises the need to find other drugs to improve obstetrical outcome. Hydroxychloroquine is widely used in patients with various autoimmune diseases, particularly SLE. Antimalarials have many anti-inflammatory, anti-aggregant and immune-regulatory properties: they inhibit phospholipase activity, stabilize lysosomal membranes, block the production of several pro-inflammatory cytokines and, in addition, impair complement-dependent antigen-antibody reactions. There is ample evidence of protective effects of hydroxychloroquine in OAPS similar to the situation in SLE arising from in vitro studies of pathophysiological working mechanism of hydroxychloroquine. However, the clinical data on the use of hydroxychloroquine in primary APS are lacking and prospective studies are necessary.
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de médecine interne, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, F-75012 Paris, France. Electronic address: arsene.mekinian@sat.aphp.fr.
authors.forename: Arsene
authors.initials: A
authors.lastname: Mekinian
authors.affiliation: Université René Descartes, Paris, France; APHP, Centre de reference malades auto-immunes et systemiques rares, Service de médecine interne, Hopital Cochin, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Costedoat-Chalumeau
authors.affiliation: Université Nantes, Nantes, France; Service de médecine interne, Hopital Nantes, Nantes, France.
authors.forename: Agathe
authors.initials: A
authors.lastname: Masseau
authors.affiliation: Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Tincani
authors.affiliation: Department of Obstetrics, Gynaecology, and Pediatrics, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: De Caroli
authors.affiliation: Systemic Autoimmune Disease Unit, Department of Internal Medicine I, Vall d'Hebrón University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Alijotas-Reig
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Amelia
authors.initials: A
authors.lastname: Ruffatti
authors.affiliation: Department of Rheumatology, University Medical Centre Ljubljana, Slovenia.
authors.forename: Ales
authors.initials: A
authors.lastname: Ambrozic
authors.affiliation: Department of Obstetrics, Gynaecology, and Pediatrics, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Botta
authors.affiliation: Université René Descartes, Paris, France; APHP, Centre de reference malades auto-immunes et systemiques rares, Service de médecine interne, Hopital Cochin, Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Le Guern
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, Netherlands.
authors.forename: Ruth
authors.initials: R
authors.lastname: Fritsch-Stork
authors.affiliation: Université Paris 7, Paris, France; AP-HP, Unité Fonctionnelles d'Immunologie «Auto-immunité et Hypersensibilités», Hôpital Bichat-Claude Bernard, Paris, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Nicaise-Roland
authors.affiliation: Université Paris 7, Paris, France; AP-HP, Service de gynécologie obstétrique, Hôpital Trousseau Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Carbonne
authors.affiliation: Université Paris 13, Bondy, France; AP-HP, Service de gynécologie-obstétrique, Hôpital Jean Verdier, 93140 Bondy, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Carbillon
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de médecine interne, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, F-75012 Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fain
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011379:Prognosis
chemical_list: D000893:Anti-Inflammatory Agents; D006886:Hydroxychloroquine
keywords: Antiphospholipid syndrome; Hydroxychloroquine; Outcome