title: The efficacy of hydroxychloroquine for obstetrical outcome in anti-phospholipid syndrome: Data from a European multicenter retrospective study.
abstract: In European multicenter study, we aimed to describe the real-life hydroxychloroquine use in APS patients during pregnancy and determine its benefit in refractory obstetrical APS. We analyzed the outcome of pregnancies treated by hydroxychloroquine in patients with APS or asymptomatic antiphospholipid (aPL) antibodies carriers. Thirty patients with APS with 35 pregnancies treated by hydroxychloroquine were analyzed. Comparing the outcome of pregnancies treated by the addition of hydroxychloroquine to previous pregnancies under the conventional treatment, pregnancy losses decreased from 81% to 19% (p<0.05), without differences in the associated treatments. The univariate analysis showed that the previous intrauterine deaths and higher hydroxychloroquine amount (400mg per day) were the factors associated with pregnancy outcome. Considering 14 patients with previous refractory obstetrical APS (n=5 with obstetrical and thrombotic primary APS and n=9 with purely obstetrical APS), all with previous pregnancy losses under treatment (aspirin with LMWH in 11 cases and LMWH in 3 cases), the addition of hydroxychloroquine resulted in live born babies in 11/14 (78%) cases (p<0.05). Our study shows the benefit of hydroxychloroquine addition in patients with refractory obstetrical APS and raises the need of prospective studies to confirm our preliminary study.
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: Arsène
authors.initials: A
authors.lastname: Mekinian
authors.affiliation: Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University and Spedali Civili of Brescia, Brescia, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Lazzaroni
authors.affiliation: Clinical Immunology AO Ordine Mauriziano, Turin, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Kuzenko
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: Département de Santé Publique, Hôpitaux Universitaires de l'Est Parisien (Tenon), Paris, France; Inserm U 1136, Paris, France; Université Pierre et Marie Curie UMR S 1136, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Levy
authors.affiliation: Istituto Scientifico Ospedale San Raffaele, Milano, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Canti
authors.affiliation: Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Katarina
authors.initials: K
authors.lastname: Bremme
authors.affiliation: Université de Limoges, Limoges, France; Service de Médecine Interne, Hôpital Limoges, Limoges, France.
authors.forename: Holy
authors.initials: H
authors.lastname: Bezanahary
authors.affiliation: Clinical Immunology AO Ordine Mauriziano, Turin, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Bertero
authors.affiliation: Université Paris 13, Bobigny, France; AP-HP, Service de Médecine Interne, Hôpital Avicenne, 93000 Bobigny, France.
authors.forename: Robin
authors.initials: R
authors.lastname: Dhote
authors.affiliation: Service de Médecine Interne, HPMetz Site Belle Isle, Metz, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Maurier
authors.affiliation: Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University and Spedali Civili of Brescia, Brescia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Andreoli
authors.affiliation: Université Paris 13, Bondy, France; AP-HP, Service de Gynécologie-Obstétrique, Hôpital Jean Verdier, 93140 Bondy, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Benbara
authors.affiliation: Université Paris 13, Bondy, France; AP-HP, Service de Gynécologie-Obstétrique, Hôpital Jean Verdier, 93140 Bondy, France.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Tigazin
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, Autoimmunité et Hypersensibilité, Hopital Bichat, Paris, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Nicaise-Roland
authors.affiliation: Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University and Spedali Civili of Brescia, Brescia, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Tincani
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: D017152:Antibodies, Antiphospholipid / Q000276:immunology; D016736:Antiphospholipid Syndrome / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D015337:Multicenter Studies as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies
chemical_list: D017152:Antibodies, Antiphospholipid; D006886:Hydroxychloroquine
keywords: Hydroxychloroquine; Obstetrical antiphospholipid syndrome; Outcome