AB0459 IMMUNOGLOBULINS COMBINED WITH STANDARD THERAPIES FOR THE PREVENTION OF RELAPSES IN REFRACTORY OBSTETRICAL ANTIPHOSPHOLIPID SYNDROME: A SERIES OF 103 CASES

Abstract

Background: Optimal standard therapy in obstetrical antiphospholipid syndrome (APS) (aspirin and LMWH) is effective in 72- 80% of pregnancies (1). Intravenous immunoglobulins (IVIG) are not more efficient than standard therapy (2, 3) and seems to be reserved to high risk pregnant APS patients (4) and/or refractory cases (5). Objectives: The main aim of this study was to analyse the outcome of pregnancies in APS patients with recurrent obstetrical event despite conventional treatment, who received IVIG. Methods: We have performed a retrospective multicentre open-labelled study (2010-2018). Results: 103 patients (107 pregnancies) with obstetrical APS from 8 international centres were included. In all cases, the previous standard treatment was inefficient. Obstetrical APS was present in 73%, while 27% had obstetrical and thrombotic APS. Median age was 28 years. Triple antiphospholipid antibody (tAPL) positivity was found in 51% of patients and lupus anticoagulant (LA) in 60%. IV IG use was associated with favourable outcome in 101/107 pregnancies (94%). In multivariate analysis, previous history of prematurity and Ig use were associated with live-birth pregnancy (odds-ratio 0.12 95%CI 0.03-0.37, p 0.005). The dosages of IV IG were variable: 0.4g/kilo day-2g/kilo day but without differences on outcomes between patients (p 0.8). There were no differences in outcomes of pregnancies between patients with tAPLand/or LA positivity and patients with other antibodies profiles (p 0.8). Conclusion: IVIG could be effective in cases of refractory obstetrical APS but prospective studies are necessary.