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

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. References [1] Cervera R, Serrano R, Pons-Estel GJ, Ceberio-Hualde L, Shoenfeld Y, de Ramon E, Buonaiuto V, Jacobsen S, Zeher MM, Tarr T, Tincani A, Taglietti M, Theodossiades G, Nomikou E, Galeazzi M, Bellisai F, Meroni PL, Derksen RH, de Groot PG, Baleva M, Mosca M, Bombardieri S, Houssiau F, Gris JC, Quere I, Hachulla E, Vasconcelos C, Fernandez-Nebro A, Haro M, Amoura Z, Miyara M, Tektonidou M, Espinosa G, Bertolaccini ML, Khamashta MA. Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis. 2015;74:1011-8. [2] Branch DW, Porter TF, Paidas MJ, Belfort MA, Gonik B. Obstetric uses of intravenous immunoglobulin: successes, failures, and promises. J Allergy Clin Immunol. 2001;108:S133-8. [3] Dendrinos S, Sakkas E, Makrakis E. Low-molecular-weight heparin versus intravenous immunoglobulin for recurrent abortion associated with antiphospholipid antibody syndrome. Int J Gynaecol Obstet. 2009;104:223-5. [4] Ruffatti A, Favaro M, Hoxha A, Zambon A, Marson P, Del Ross T, Calligaro A, Tonello M, Nardelli GB. Apheresis and intravenous immunoglobulins used in addition to conventional therapy to treat high-risk pregnant antiphospholipid antibody syndrome patients. A prospective study. J Reprod Immunol. 2016;115:14-9. [5] Prete M, Urso L, Fatone MC, Pinto V, Perosa F. Antiphospholipids Syndrome Complicated by a Systemic Capillary Leak-Like Syndrome Treated With Steroids and Intravenous Immunoglobulins: A Case Report. Medicine. 2016;95:e2648. Disclosure of Interests: None declared