P280 Maternal use of hydroxychloroquine with anti-Ro and or anti-La during pregnancy: a systematic review

Abstract

Abstract Background/Aims Anti-Ro antibody and, to a lesser extent, anti-La antibody have been associated with fetal heart block during pregnancy. Use of hydroxychloroquine has previously been shown to reduce this risk in pregnancy. According to ACR 2020, all women with positive anti-Ro and or anti-La antibodies are conditionally advised to commence HCQ during pregnancy, but this is based on limited data. We performed a systematic review to evaluate the prevalence of hydroxychloroquine prescription in women with anti-Ro or La antibodies and examine the prevalence of congenital heart block. Methods This was a systematic review of case controlled and observational studies. A PICO model was used to design the research question. Literature searches were initiated based on five keywords: hydroxychloroquine, pregnancy(antenatal), maternal, anti-Ro(SSA), anti-La(SSB). Studies were retrieved from Pubmed, MEDLINE, Mendeley, Cochrane, University College Dublin Library using relevant search strategies from inception to May 2021. The search was restricted to English language articles only. Data were extracted and cross-checked by two reviewers. Results Sixteen studies involving 1,706 anti-Ro and 454 anti-La positive females, resulting in 2,279 pregnancies, were eligible for inclusion in this review. Mean age was 30.7 years at gestation. The prevalence of HCQ prescription in pregnancy in Ro+ women was 32.7%. The most common diagnoses were systemic lupus erythematosus (n = 990) and Sjögren’s syndrome (n = 452), while the remaining women had rheumatoid arthritis, antiphospholipid syndrome, undifferentiated connective tissue disease, scleroderma, autoimmune thyroiditis, dermatomyositis, polychondritis and overlap conditions. Eight studies included asymptomatic antibody carriers (n = 192). The prevalence of congenital heart block in neonates of women on HCQ in pregnancy was 1.8%. Due to issues with data reporting in the included studies, it was not possible to separate out Ro+ women on HCQ from those not on HCQ. For this reason, we could not compare and draw conclusions on the prevalence of CHB in pregnancies of Ro+ women. Conclusion This systematic review highlights the need for additional studies to examine use of HCQ in women positive for Ro or La antibodies. While these antibodies are commonly encountered in SLE and Sjögren’s syndrome, they can occur in other rheumatic diseases and should be screened for to limit risk of CHB. Disclosure S.A. Al Nokhatha: None. S. Maguire: None. R. Harrington: None.