title: Emerging Therapies in Antiphospholipid Syndrome.
abstract: Antiphospholipid syndrome (APS) is a hypercoagulable state characterized by arterial and venous thromboses and pregnancy morbidity in the presence of antiphospholipid antibodies. Although warfarin remains the main therapeutic choice in APS, there is still concern about its efficacy, safety, and patient compliance. Patients with refractory APS to conventional therapy as well as patients with non-classical manifestations of APS may have alternative treatment approaches. APS pathogenesis has been further elucidated over the past years identifying new molecules as potential new treatment targets. This review summarizes available data from in vitro and animal models and clinical studies on the role of new potential treatment approaches including new oral anticoagulants and immunoregulatory agents: direct thrombin or factor Xa inhibitors, hydroxychloroquine, statins, B cell inhibition, complement inhibition, peptide therapy, nuclear factor κB and p38 mitogen-activated kinase inhibitors, defibrotide, abciximab, mTOR inhibitor, and other potential targets. Large multicenter prospective studies of well-characterized APS patients are needed to assess the efficacy and safety profile of these potential treatment alternatives.
authors.affiliation: Rheumatology Department, University of São Paulo, Av. Dr. Arnaldo 455, Third Floor, Room 3109, São Paulo, Brazil.
authors.forename: Danieli
authors.initials: D
authors.lastname: Andrade
authors.affiliation: First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Programme, National and Kapodistrian University of Athens, Athens, Greece. mtektonidou@gmail.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Tektonidou
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000188:drug therapy* / Q000209:etiology; D051056:Complement Inactivating Agents / Q000627:therapeutic use; D004195:Disease Models, Animal; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D058990:Molecular Targeted Therapy / Q000379:methods; D013927:Thrombosis / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D051056:Complement Inactivating Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007155:Immunologic Factors; D006886:Hydroxychloroquine
keywords: Animal models; Antiphospholipid syndrome (APS); Clinical studies; Immunoregulatory agents; In vitro studies; New treatments; Oral anticoagulants; Pathogenesis; Warfarin