Obstetrical APS: is there a place for hydroxychloroquine to improve the pregnancy outcome?

Arsene Mekinian; Nathalie Costedoat-Chalumeau; Agathe Masseau; Angela Tincani; Sara De Caroli; Jaume Alijotas-Reig; Amelia Ruffatti; Ales Ambrozic; Angela Botta; Véronique Le Guern; Ruth Fritsch-Stork; Pascale Nicaise-Roland; Bruno Carbonne; Lionel Carbillon; Olivier Fain

doi:10.1016/j.autrev.2014.08.040

Obstetrical APS: is there a place for hydroxychloroquine to improve the pregnancy outcome?

Autoimmun Rev. 2015 Jan;14(1):23-9. doi: 10.1016/j.autrev.2014.08.040. Epub 2014 Aug 30.

Authors

Affiliations

¹ 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.
² Université René Descartes, Paris, France; APHP, Centre de reference malades auto-immunes et systemiques rares, Service de médecine interne, Hopital Cochin, Paris, France.
³ Université Nantes, Nantes, France; Service de médecine interne, Hopital Nantes, Nantes, France.
⁴ Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
⁵ Department of Obstetrics, Gynaecology, and Pediatrics, Catholic University of Sacred Heart, Rome, Italy.
⁶ Systemic Autoimmune Disease Unit, Department of Internal Medicine I, Vall d'Hebrón University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain.
⁷ Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy.
⁸ Department of Rheumatology, University Medical Centre Ljubljana, Slovenia.
⁹ Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, Netherlands.
¹⁰ Université Paris 7, Paris, France; AP-HP, Unité Fonctionnelles d'Immunologie «Auto-immunité et Hypersensibilités», Hôpital Bichat-Claude Bernard, Paris, France.
¹¹ Université Paris 7, Paris, France; AP-HP, Service de gynécologie obstétrique, Hôpital Trousseau Paris, France.
¹² Université Paris 13, Bondy, France; AP-HP, Service de gynécologie-obstétrique, Hôpital Jean Verdier, 93140 Bondy, France.
¹³ 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.

PMID: 25179813
DOI: 10.1016/j.autrev.2014.08.040

Abstract

The use of the conventional APS treatment (the combination of low-dose aspirin and LMWH) dramatically improved the obstetrical prognosis in primary obstetrical APS (OAPS). The persistence of adverse pregnancy outcome raises the need to find other drugs to improve obstetrical outcome. Hydroxychloroquine is widely used in patients with various autoimmune diseases, particularly SLE. Antimalarials have many anti-inflammatory, anti-aggregant and immune-regulatory properties: they inhibit phospholipase activity, stabilize lysosomal membranes, block the production of several pro-inflammatory cytokines and, in addition, impair complement-dependent antigen-antibody reactions. There is ample evidence of protective effects of hydroxychloroquine in OAPS similar to the situation in SLE arising from in vitro studies of pathophysiological working mechanism of hydroxychloroquine. However, the clinical data on the use of hydroxychloroquine in primary APS are lacking and prospective studies are necessary.

Keywords: Antiphospholipid syndrome; Hydroxychloroquine; Outcome.

Publication types

Review

MeSH terms

Anti-Inflammatory Agents / therapeutic use*
Antiphospholipid Syndrome / complications*
Antiphospholipid Syndrome / drug therapy*
Female
Humans
Hydroxychloroquine / therapeutic use*
Pregnancy
Pregnancy Complications / prevention & control*
Pregnancy Outcome*
Prognosis

Substances

Anti-Inflammatory Agents
Hydroxychloroquine