Girls with systemic lupus erythematous (SLE) who are at possibility for preeclampsia might perhaps well salvage pleasure from successfully timed therapy with low-dose aspirin and most definitely hydroxychloroquine, in step with German researchers.
In a capacity, valid-world look of 190 pregnancies in 148 women (moderate age, ~30 years), the use of low-dose aspirin beginning across the 16th week of gestation became linked with a lower possibility for preeclampsia than became no aspirin use (adjusted odds ratio [aOR], 0.21; P < .05).
The use of hydroxychloroquine starting in the first trimester had a “moderating effect,” said Isabell Haase, MD, a senior clinician scientist in the Department of Rheumatology at Hiller-Research Unit, Düsseldorf, Germany. Although this was not a statistically significant effect (aOR, 0.47; P = .21), the association strengthened if only high-risk pregnancies were considered (aOR, 0.28; P = .075).
“I think this once more shows us that counseling and risk assessment in our lupus patients is very important to find out those with the highest risk and treat them as good as possible,” Haase said. She was speaking at the 14th International Congress on Systemic Lupus Erythematosus and 6th International Congress on Controversies in Rheumatology and Autoimmunity (LUPUS & CORA 2021).
Preeclampsia and Lupus
“Women with SLE face a high risk of preeclampsia because of their autoimmune disease,” Haase explained. “This [risk] can be further increased if a woman carries additional risk factors, like hypertension or lupus nephritis.”
Low-dose aspirin is known to protect against the development of preeclampsia in women without autoimmune disease if started before the 16th gestational week of pregnancy, Haase added. That is why it’s recommended by both the American College of Rheumatology and the European Alliance of Associations for Rheumatology.
“For hydroxychloroquine, we only have some small studies and its mechanism of action that lead us to the idea that it could also have a beneficial effect on preeclampsia in lupus patients,” she said.
Study Design and Results
The aim of the study was to see in a real-world cohort whether there was any beneficial effect of either aspirin or hydroxychloroquine regarding the development of preeclampsia.
The researchers used prospectively collected data from pregnancies seen at an outpatient pregnancy clinic during 1995–2019. They used multiple logistic regression to determine whether there was any effect of four treatments on the development of preeclampsia: aspirin (n = 39 patients) or hydroxychloroquine (n = 39) alone, in combination (n = 43), or neither drug (n = 69).
Overall, 56% of the women had significant risk factors for preeclampsia, including a prior history, multifetal gestation, chronic hypertension, lupus nephritis, or antiphospholipid antibodies (aPL). A further 28% had moderate risk factors, including not having had children, a body mass index (BMI) >30 kg/m2, and being older than 35 years.
The total price of preeclampsia in the look inhabitants became 13.2%, “which is in step with other studies in lupus pregnancies,” Haase acknowledged. Rates in each and every of the four therapy groups were 15.4% with aspirin by myself, 7.7% with hydroxychloroquine by myself, 14% with each and every capsules, and 14.5% with neither.
The percentages of increasing preeclampsia were lower with each and every aspirin and hydroxychloroquine. Components that raised the percentages were excessive illness exercise in the critical trimester (aOR, 4.55), a BMI of >30 kg/m2 (aOR, 6.14), having excessive-possibility aPL or antiphospholipid syndrome (aOR, 8.02), and a historical previous of preeclampsia (aOR, 9.78).
Most attention-grabbing excessive illness exercise in the critical trimester and BMI >30 kg/m2 remained self sustaining predictors of preeclampsia when the researchers regarded as ideal excessive-possibility pregnancies (aOR, 7.74 for excessive illness exercise in first trimester and 10.04 for a excessive BMI).
The consequences are “actually spectacular,” acknowledged Angela Tincani, MD, senior consultant at the Rheumatology and Clinical Immunology Unit of ASST–Spedali Civili di Brescia, in Italy.
Tincani noticed that the look had covered a “big variety of years” (1995–2020).
“I feel that our perspective in having a peek after lupus patients [changed] for the interval of this time,” she acknowledged.
“For event, I feel that we potentially use less corticosteroids now than in the 90s,” she acknowledged.
When asked whether or no longer changes in practices have influenced the findings, she acknowledged, “It is doubtless you’ll maybe maybe compare that the prescription of the many medications has modified plenty. We also realizing that we’ve to take be aware of the years as a confounder, but we have not statistically analyzed that, but it completely’s positively one thing that we are going to compose next.”
The look bought no out of doors funding. Haase has bought saunter fees from AbbVie, Celgene, Chugai, Janssen-Cilag, Eli Lilly, and Medac. Tincani has disclosed no relevant financial relationships.
14th International Congress on Systemic Lupus Erythematosus (LUPUS 2021) and the sixth International Congress on Controversies in Rheumatology and Autoimmunity (CORA). Oral Presentation. October 9, 2021.
Sara Freeman is a UK-essentially essentially based fully clinical journalist who specializes in clinical convention reporting and protest material for web sites. Command her on Twitter @Sara_MedWriter.