HYDROXYCHLOROQUINE (HCQ) IN PRIMARY OBSTETRICAL ANTI-PHOSPHOLIPID SYNDROME (OAPS): PROSPECTIVE STUDY OF THE EFFICACY OF HCQ IN PRIMARY OAPS
- Suzan Abou-Raya, Egypt
Abstract
Background and Aims
Antimalarials have pleiotropic functions including anti-inflammatory, anti-aggrecant and immunoregulatory properties. Adverse pregnancy outcomes in primary OAPS despite anticoagulation, dictates the need for further measures. Experimental evidence exists that HCQ might decrease the incidence of thrombosis. The aim of the present study was to determine the effectiveness and to assess safety of HCQ during OAPS pregnancy (maternal and foetal outcome).
Methods
A total of 34 pregnant patients, (mean age 36.2 years and mean disease duration 4.2 years) with similar characteristics (age, sex, body mass index, ethnicity, disease duration) diagnosed according to the revised international criteria were recruited. All patients were prescribed low dose aspirin and low molecular weight heparin as well as HCQ 200 mg bid throughout the pregnancy. Thrombotic incidence before, during and after the pregnancy was analysed. Lupus anticoagulant was positive in 33(97%) cases, anticardiolipin antibodies were positive in 31(91%) cases; IgG was positive in 32(94 %), IgM positive in 31(91%) and anti-b2 glycoprotein antibodies were positive in 32 (94%) of cases.
Results
Thirty-two cases (94%) had successful pregnancy. Two patients (5.9%) had premature delivery. No fatal cases were recorded. No congenital abnormalities were observed and mean follow up of 24 months revealed no abnormalities in the infants. No new thrombi (arterial and venous) were recorded throughout the pregnancy. Previous events of vascular thrombosis (arterial and/or venous) were recorded at diagnosis in 42% of patients, previous obstetrical event in 38%, both venous and arterial thrombosis in 26% of cases.
Conclusions
The “immunomodulatory” approach of HCQ is effective in improving pregnancy outcome in primary OAPS.