Javier Carbone, Spain
Clinica Santa Elena Clinical ImmunologyPresenter of 2 Presentations
THE POTENTIAL ROLE OF LOW-DOSE PREDNISONE FOR THE THERAPY OF AUTOIMMUNE REPRODUCTIVE FAILURE
Abstract
Background and Aims
Recurrent reproductive failure includes repeated pregnancy loss or implantation failure. The only accepted immunological abnormality of recurrent pregnancy loss in international guidelines is the presence of antiphospholipid antibodies. There are no well-accepted immunological factors of repeated implantation failure. However distinct studies have demonstrated the potential role of other autoantibodies mainly among women with recurrent pregnancy loss. In this study we preliminary evaluated the efficacy and safety of low-dose prednisone in a small number of women with autoimmune reproductive failure.
Methods
In this study we defined autoimmune reproductive failure as a previous history of primary recurrent pregnancy loss (more than 3 pregnancy losses) or recurrent implantation failure in the presence of antinuclear or anti-thyroid antibodies with or without C3 or C4 hypocomplementemia. None of the patients disclosed full-blown SLE. After informed consent the women were treated with low-dose prednisone (10 mg/day) from the day of a positive pregnancy test to week 12 of pregnancy. A prospective follow-up was performed to assess efficacy and safety.
Results
4 out of 12 women with autoimmune reproductive failure were treated with low-dose prednisone. During follow-up none of these patients developed severe infections, diabetes, arterial hypertension or pre-eclampsia. All women delivered healthy newborns with normal APGAR scores. None of the infants were born prematurely.
Conclusions
Treating women who had antinuclear antibodies and recurrent reproductive failure with low-dose prednisone during the first 3 months of pregnancy was effective in promoting live birth in a small serie of cases. The role of this immuneguided therapy warrants evaluation in a clinical trial.
EFFICACY AND SAFETY OF SUBCUTANEOUS TOCILIZUMAB FOR THYROID EYE DISEASE
Abstract
Background and Aims
Intravenous tocilizumab is a therapy for moderate-severe active thyroid eye disease. We decribe efficacy and safety of subcutaneous tocilizumab in a patient with thyroid eye disease.
Methods
A 41-year-old white, non smoker, woman disclosed a 3-year history of hyperthyroidism. Partial response of thyroid function after methimazole and carbimazole was observed. Bilateral eye changes developed including upper eyelid inflammation, limitation of extraocular motility with eye proptosis, with important impact in her quality of life. The CAS was 4 on a scale of 7. Laboratory tests revealed free T4 2.4 pmol/L, low thyroid-stiumulating hormone (0.01 mIU/L), high anti-TSH-receptor antibodies (26.8 IU/L) and high serum IL-6 levels (14.84 ng/L, n.v. 0.00-6.40). IL2-R levels (556 U/mL) and regulatory CD4+CD25+CD127+ percentages (2.2%) were normal. After discussing with the patient therapeutical options we decided administer subcutaneous tocilizumab 162 mg each 8-9 days for a total of 16 doses (8 mg/kg/month). Baseline safety evaluation (complete blood count, immunoglobulin, complement, lymphocyte subset levels, liver function testing and tuberculosis screening) was normal. Pneumococcal vaccine was administered.
Results
After the first four doses of subcutaneous tocilizumab a significant improvement of thyroid eye disease with reduction of proptosis, eye symptoms and extraocular motility was observed. Infusions were were tolerated. No adverse reactions were observed. Laboratory tests revealed low thyroid-stimulating hormone (<0.01 mIU/L), a decrease of anti-TSH-receptor antibodies (from 26.8 to 9 IU/L and normal liver function tests.
Conclusions
Subcutaneous tocilizumab was efficacious and safe in a patient with thyroid eye disease. The potential role of this therapy should be evaluated in a clinical trial.