Department of Obstetrics and Gynaecology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Center of Research of Immunopathology and Rare Diseases - Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy.
Curr Opin Obstet Gynecol. 2020 Oct;32(5):351-358. doi: 10.1097/GCO.0000000000000649.
Pregnancies in women with antiphospholipid antibodies (aPL) are associated with several pregnancy complications. The current treatment to prevent obstetric aPL-mediated morbidity is largely based on low-dose aspirin (LDA) and low-molecular-weight heparin (LMWH). Alternative treatment regimens to prevent obstetric aPL-related morbidity include the addition of the antimalarial hydroxychloroquine (HCQ). The aim of this systematic review is to identify the currently available evidence on the efficacy of HCQ to prevent aPL-related obstetric morbidity.
We identified four retrospective observational studies. No definite signal of harm was identified as none of the studies reported adverse outcomes. When comparing a total of 214 aPL-positive women with a total of 250 HCQ-exposed aPL-positive pregnancies and 521 pregnancies not exposed to HCQ, we found that HCQ exposure was not associated with an increased rate of live births [pooled OR 1.33; 95% confidence interval (CI) 0.62--2.86]). There was considerable heterogeneity in the analysis (I = 59%).
HCQ seems well tolerated in pregnancy. However, because of the heterogeneity of available studies, the questions whether women with aPL (or some subpopulation of those) might benefit from this agent during pregnancy remains unanswered. Randomized controlled data are needed.
抗磷脂抗体（aPL）阳性妇女的妊娠与多种妊娠并发症相关。目前预防产科 aPL 相关不良妊娠结局的治疗方法主要基于低剂量阿司匹林（LDA）和低分子肝素（LMWH）。预防产科 aPL 相关不良妊娠结局的替代治疗方案包括添加抗疟药羟氯喹（HCQ）。本系统综述的目的是确定目前关于 HCQ 预防 aPL 相关产科不良结局的疗效的证据。
我们确定了四项回顾性观察性研究。由于没有研究报告不良结局，因此没有确定明显的危害信号。当比较总共 214 名 aPL 阳性妇女的总共 250 例 HCQ 暴露的 aPL 阳性妊娠和 521 例未暴露于 HCQ 的妊娠时，我们发现 HCQ 暴露与活产率增加无关[汇总 OR 1.33；95%置信区间（CI）0.62-2.86]。分析存在很大的异质性（I = 59%）。
HCQ 在妊娠期间似乎耐受性良好。然而，由于现有研究的异质性，关于 aPL 妇女（或其中一些亚群）是否可能从这种药物中获益的问题仍未得到解答。需要随机对照数据。
