16th International Congress on Antiphospholipid Antibodies Task Force Report on Antiphospholipid Syndrome Treatment Trends

Hannah Cohen^{1

2}, Maria J Cuadrado³, Doruk Erkan⁴, Ali Duarte-Garcia^{5

6}, David A Isenberg^{2

7}, Jason S Knight⁸, Thomas L Ortel⁹, Anisur Rahman⁷, Jane E Salmon¹⁰, Maria G Tektonidou¹¹, David J Williams^{2

12}, Rohan Willis¹³, Scott C Woller¹⁴, Danieli Andrade¹⁵

Affiliations

¹ Haemostasis Research Unit, Department of Haematology, University College London, London, UK.
² University College London Hospitals NHS Foundation Trust, London, UK.
³ Rheumatology Department, Clinica Universidad de Navarra, Madrid, Spain.
⁴ Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA.
⁵ Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
⁷ Centre for Rheumatology, Division of Medicine, University College London, London, UK.
⁸ Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA.
⁹ Division of Hematology, Department of Medicine, and Department of Pathology, Duke University Medical Center, Durham, NC, USA.
¹⁰ Division of Rheumatology, Hospital for Special surgery, Weill Cornell Medicine, New York, NY, USA.
¹¹ First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece.
¹² UCL EGA Institute for Women's Health, University College London, London, UK.
¹³ Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, TX, USA.
¹⁴ Department of Medicine, Intermountain Medical Center, Murray UT; Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
¹⁵ University of São Paulo, São Paulo, Brazil.

PMID: 33100166
PMCID: PMC7658424
DOI: 10.1177/0961203320950461

Review

16th International Congress on Antiphospholipid Antibodies Task Force Report on Antiphospholipid Syndrome Treatment Trends

Hannah Cohen et al. Lupus. 2020 Oct.

. 2020 Oct;29(12):1571-1593.

doi: 10.1177/0961203320950461.

Authors

Affiliations

¹ Haemostasis Research Unit, Department of Haematology, University College London, London, UK.
² University College London Hospitals NHS Foundation Trust, London, UK.
³ Rheumatology Department, Clinica Universidad de Navarra, Madrid, Spain.
⁴ Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA.
⁵ Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
⁷ Centre for Rheumatology, Division of Medicine, University College London, London, UK.
⁸ Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA.
⁹ Division of Hematology, Department of Medicine, and Department of Pathology, Duke University Medical Center, Durham, NC, USA.
¹⁰ Division of Rheumatology, Hospital for Special surgery, Weill Cornell Medicine, New York, NY, USA.
¹¹ First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece.
¹² UCL EGA Institute for Women's Health, University College London, London, UK.
¹³ Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, TX, USA.
¹⁴ Department of Medicine, Intermountain Medical Center, Murray UT; Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
¹⁵ University of São Paulo, São Paulo, Brazil.

PMID: 33100166
PMCID: PMC7658424
DOI: 10.1177/0961203320950461

Abstract

Antiphospholipid syndrome (APS), an acquired autoimmune thrombophilia, is characterised by thrombosis and/or pregnancy morbidity in association with persistent antiphospholipid antibodies. The 16th International Congress on Antiphospholipid Antibodies Task Force on APS Treatment Trends reviewed the current status with regard to existing and novel treatment trends for APS, which is the focus of this Task Force report. The report addresses current treatments and developments since the last report, on the use of direct oral anticoagulants in patients with APS, antiplatelet agents, adjunctive therapies (hydroxychloroquine, statins and vitamin D), targeted treatment including rituximab, belimumab, and anti-TNF agents, complement inhibition and drugs based on peptides of beta-2-glycoprotein I. In addition, the report summarises potential new players, including coenzyme Q10, adenosine receptor agonists and adenosine potentiation. In each case, the report provides recommendations for clinicians, based on the current state of the art, and suggests a clinical research agenda. The initiation and development of appropriate clinical studies requires a focus on devising suitable outcome measures, including a disease activity index, an optimal damage index, and a specific quality of life index.

Keywords: Antiphospholipid syndrome; anti-β2-glycoprotein I peptides; biologics; complement inhibition; direct oral anticoagulants; potential new players.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: HC reports, outside the submitted work, institutional research support and support to attend scientific meetings from Bayer Healthcare, with honoraria for lectures from Bayer Healthcare and consultancy fees from UCB paid to University College London Hospitals Charity; DE reports, outside the submitted work, consulting fees from GSK, Exagen and UCB, and research support from American College of Rheumatology, European League Against Rheumatism, Lupus Clinical Trials Consortium, National Institute of Allergy and Infectious Disease, and GSK; JSK reports, outside the submitted work, funding from Jazz Pharmaceuticals for preclinical studies of defibrotide; TLO reports, outside the submitted work, consulting fees from Instrumentation Laboratory and research support from Instrumentation Laboratory and Siemens; AR is a co-inventor on a patent to develop PEGylated Domain I of beta-2-glycoprotein I as a novel therapy for APS; JE Salmon reports, outside the submitted work, support of an investigator-initiated grant form UCB and consultancy fees from Admirx, Akari, BMS, Realta, and UCB; MGT reports, outside the submitted work, consultant fees and unrestricted grants from AbbVie, MSD, Novartis, Pfizer, GSK and UCB deposited to the Special Account for Research Funding (ELKE) of the National and Kapodistrian University of Athens Medical School; SW reports, outside the submitted work, grant support from Bristol‐Meyers‐Squibb/Pfizer Alliance paid to Intermountain Healthcare, and service as co-chair for the American College of Chest Physicians panelists guideline update for the treatment of venous thromboembolism; DJW reports, outside the submitted work, being Chief Clinical investigator of the Stamp Trial; and current research funding from the UK Medical Research Council, Wellbeing of Women, Chief Scientist Office Scotland, Rosetrees Trust and EGA Charity. MJC, A D-G, DA, DAI and RW have nothing to disclose.

References

1. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4: 295–306. doi:10.1111/j.1538-7836.2006.01753.x - PubMed
1. Duarte‐García A, Pham MM, Crowson CS, et al. The epidemiology of antiphospholipid syndrome: a population‐based study. Arthritis Rheumatol 2019; 71: 1545–1552. doi:10.1002/art.40901 - PMC - PubMed
1. Cervera R, Piette J-C, Font J, Euro-Phospholipid Project Group et al. Antiphospholipid syndrome: Clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients: Clinical and immunologic manifestations of APS. Arthritis Rheum 2002; 46: 1019–1027. - PubMed
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16th International Congress on Antiphospholipid Antibodies Task Force Report on Antiphospholipid Syndrome Treatment Trends

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16th International Congress on Antiphospholipid Antibodies Task Force Report on Antiphospholipid Syndrome Treatment Trends

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