title: Catastrophic antiphospholipid syndrome: The current management approach.
abstract: The current recommendation for catastrophic antiphospholipid syndrome (CAPS) management is the standard triple therapy with anticoagulation (AC), glucocorticoids (GCs), plasma exchange (PE), and/or intravenous immunoglobulins (IVIGs). Of note, only AC has a significant effect on the prognosis of these patients. However, from the experimental or basic point of view, there is only indirect evidence to advocate the use of these immunomodulatory therapies (GC, PE, and IVIG) in CAPS. Recently, there have been reports of severe or refractory CAPS patients treated with the monoclonal antibodies rituximab and eculizumab. The first blocks CD20, a surface protein expressed on the cytoplasmic membrane of B cells, and decreases the generation of pathogenic autoantibodies such as antiphospholipid (aPL) antibodies. The second binds with high affinity to C5 complement protein, inhibiting its cleavage and thus preventing the generation of C5b-C9 complex.
authors.affiliation: Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Rodriguez-Pintó
authors.affiliation: Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain.
authors.forename: Gerard
authors.initials: G
authors.lastname: Espinosa
authors.affiliation: Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain. Electronic address: rcervera@clinic.cat.
authors.forename: Ricard
authors.initials: R
authors.lastname: Cervera
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000276:immunology / Q000628:therapy*; D002388:Catastrophic Illness; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D010951:Plasma Exchange / Q000379:methods; D011379:Prognosis; D000069283:Rituximab / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000925:Anticoagulants; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D000069283:Rituximab; C481642:eculizumab
keywords: Anticoagulation; Catastrophic antiphospholipid syndrome; Corticoids; Eculizumab; Intravenous immunoglobulins; Plasma exchange; Review; Rituximab; Sirolimus; Therapeutics