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.
Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University and Spedali Civili of Brescia, Brescia, Italy.
Autoimmun Rev. 2015 Jun;14(6):498-502. doi: 10.1016/j.autrev.2015.01.012. Epub 2015 Jan 21.
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.
在这项欧洲多中心研究中，我们旨在描述羟氯喹在 APS 患者妊娠期间的真实应用情况，并确定其在难治性产科 APS 中的获益。我们分析了羟氯喹治疗的 APS 或无症状抗磷脂（aPL）抗体携带者妊娠的结局。分析了 30 例 APS 患者（35 次妊娠）接受羟氯喹治疗的情况。与传统治疗下既往妊娠加用羟氯喹的结局相比，妊娠丢失率从 81%降至 19%（p<0.05），但相关治疗无差异。单因素分析显示，既往宫内死亡和羟氯喹用量较高（400mg/天）是与妊娠结局相关的因素。考虑到 14 例既往难治性产科 APS 患者（5 例产科和血栓性原发性 APS，9 例单纯产科 APS），所有患者既往妊娠均因治疗而丢失（11 例采用阿司匹林联合低分子肝素，3 例采用低分子肝素），加用羟氯喹后 11/14 例（78%）活产（p<0.05）。我们的研究表明羟氯喹加用对难治性产科 APS 患者有益，并需要前瞻性研究来证实我们的初步研究。
