Prevalence, outcome and management of patients with SLE and secondary antiphospholipid antibody syndrome after aPL seroconversion
Abstract
OBJECTIVE: The withdrawal of oral anticoagulation (OAC) in patients with SLE and secondary aPL syndrome (SAPS) who become seronegative has not been clearly investigated to date. Our aim was to evaluate the prevalence of aPL seroconversion and the prognosis of SLE patients with SAPS who withdrew OAC after aPL negativization. METHODS: We retrospectively analysed data of all SLE patients (ACR criteria) with SAPS (Sydney criteria) prospectively followed-up in our clinic. aPL seroconversion was defined as negativization of lupus anticoagulant, aCL, and anti-β2glycoprotein-1 antibodies on two or more consecutive measurements, at least 12 weeks apart. OAC discontinuation was defined as the definitive withdrawal of all anticoagulants. RESULTS: Fifty-five out of 513 (10.7%) SLE patients had vascular SAPS. Sixteen patients (29.1%) became aPL seronegative during follow-up. Immunosuppressive therapy predicted aPL negativization (odds ratio 5.211, 95%CI 1.341, 20.243), whereas APS diagnosis prior to that of SLE (odds ratio 0.078, 95%CI 0.008, 0.799) and triple-positive profile (odds ratio 0.264, 95%CI 0.115, 0.609) were negative predictors of aPL negativization. OAC was discontinued in 13/55 patients (23.6%), after a median follow-up of 45 months (range 1-276) from aPL seroconversion. SLE-related modifiable risk factors for thrombosis were observed in 10/13 patients (77%) at the time of the thrombotic event. No thrombotic recurrences were observed during a mean follow-up time of 44 (19) months from OAC discontinuation. CONCLUSIONS: Our results suggest that OAC can be safely discontinued in SLE patients who became persistently seronegative for aPL, at least when aPL-related thrombotic events occurred in presence of other thrombotic risk factors.
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In that study, triple positivity and diagnosis of APS prior to SLE were predictive of aPL stability over time.
“Treatment with immunosuppression was predictive of development of seronegativity, whereas triple positivity and diagnosis of APS prior to SLE were predictive of aPL stability over time.10”
From Lupus anticoagulant test persistence over time and its associations with future thrombotic events (2022) · cites this paper as [10]
In that study, treatment with immunosuppression was predictive of development of seronegativity.
“Treatment with immunosuppression was predictive of development of seronegativity, whereas triple positivity and diagnosis of APS prior to SLE were predictive of aPL stability over time.10”
From Lupus anticoagulant test persistence over time and its associations with future thrombotic events (2022) · cites this paper as [10]
The analysis cannot be applied to patients with APS who became persistently negative for aPL and in whom anticoagulation was safely discontinued.
“There have been a number of reports of safe discontinuation of anticoagulation in patients with APS who became persistently negative for aPL, and our analysis cannot be applied to these patients.10,37”
From Lupus anticoagulant test persistence over time and its associations with future thrombotic events (2022) · cites this paper as [10]
The proportion of patients in the cohort who remained persistently LA+ (72%) was similar to rates in other studies that used different definitions of LA stability and positivity (78% in Gkrouzman et al, 71% in Zen et al, and 87% in Erkan et al).
“However, the proportion of patients in our cohort who remained persistently LA+ (72%) was similar to the rates in other studies that used different definitions of LA stability and positivity (78% in the study by Gkrouzman et al, 71% in the study by Zen et al, and 87% in study by Erkan et al.).9,10,36”
From Lupus anticoagulant test persistence over time and its associations with future thrombotic events (2022) · cites this paper as [10]
Cites
Hochberg, M. C. (1997) · Arthritis & Rheumatism · doi:10.1002/art.1780400928 · Cited by 11,409 · see citing works
MIYAKIS, S., LOCKSHIN, M. D., ATSUMI, T., BRANCH, D. W., BREY, R. L., CERVERA, R., DERKSEN, R. H. W. M., DE GROOT, P. G., KOIKE, T., MERONI, P. L., et al. (2006) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2006.01753.x · Cited by 7,203 · see citing works
Cervera, R., Piette, J., Font, J., Khamashta, M. A., Shoenfeld, Y., Camps, M. T., Jacobsen, S., Lakos, G., Tincani, A., Kontopoulou‐Griva, I., et al. (2002) · Arthritis & Rheumatism · doi:10.1002/art.10187 · Cited by 2,156 · see citing works
EULAR recommendations for the management of antiphospholipid syndrome in adults
Tektonidou, M. G., Andreoli, L., Limper, M., Amoura, Z., Cervera, R., Costedoat-Chalumeau, N., Cuadrado, M. J., Dörner, T., Ferrer-Oliveras, R., Hambly, K., et al. (2019) · Annals of the Rheumatic Diseases · doi:10.1136/annrheumdis-2019-215213 · Cited by 1,261 · see citing works
Cervera, R., Serrano, R., Pons-Estel, G. J., Ceberio-Hualde, L., Shoenfeld, Y., de Ramón, E., Buonaiuto, V, Jacobsen, S., Zeher, M. M., Tarr, T., et al. (2015) · Annals of the Rheumatic Diseases · doi:10.1136/annrheumdis-2013-204838 · Cited by 974 · see citing works
Vianna, J. L., Khamashta, M. A., Ordi, J., Font, J. A., Cervera, R., López‐Soto, A., Tolosa, C., Franz, J. K., Selva-O’Callaghan, A., Ingelmo, M., et al. (1994) · The American Journal of Medicine · doi:10.1016/0002-9343(94)90108-2 · Cited by 466 · see citing works
Erkan, D., Vega, J., Ramón, G., Kozora, E., & Lockshin, M. D. (2012) · Arthritis & Rheumatism · doi:10.1002/art.37759 · Cited by 280 · see citing works
Laboratory criteria for antiphospholipid syndrome: communication from the SSC of the ISTH
Devreese, K. M. J., Ortel, T. L., Pengo, V., & de Laat, B. (2018) · Journal of Thrombosis and Haemostasis · doi:10.1111/jth.13976 · Cited by 269 · see citing works
Petri, M. (2011) · Current Rheumatology Reports · doi:10.1007/s11926-010-0141-y · Cited by 206 · see citing works
New therapeutic strategies in systemic lupus erythematosus management
Gatto, M., Zen, M., Iaccarino, L., & Doria, A. (2018) · Nature Reviews Rheumatology · doi:10.1038/s41584-018-0133-2 · Cited by 186 · see citing works
Self-citationRuffatti, A., Del Ross, T., Ciprian, M., Bertero, M. T., Salvatore, S., Scarpato, S., Montecucco, C., Rossi, S., Caramaschi, P., Biasi, D., et al. (2011) · Annals of the Rheumatic Diseases · doi:10.1136/ard.2010.142042 · Cited by 184 · see citing works
Self-citationNuri, E., Taraborelli, M., Andreoli, L., Tonello, M., Gerosa, M., Calligaro, A., Argolini, L. M., Kumar, R., Pengo, V., Meroni, P. L., et al. (2017) · Immunologic Research · doi:10.1007/s12026-016-8812-z · Cited by 124 · see citing works
Primary antiphospholipid syndrome as the forerunner of systemic lupus erythematosus
Tarr, T., Lakos, G., Bhattoa, H. P., Szegedi, G., Shoenfeld, Y., & Kiss, E. (2007) · Lupus · doi:10.1177/0961203307077993 · Cited by 64 · see citing works
Zen, M., Saccon, F., Gatto, M., Montesso, G., Larosa, M., Benvenuti, F., Iaccarino, L., & Doria, A. (2019) · Rheumatology · doi:10.1093/rheumatology/kez422 · Cited by 59 · see citing works
Self-citationColoma Bazán, E., Donate López, C., Moreno Lozano, P., Cervera, R., & Espinosa, G. (2013) · Immunologic Research · doi:10.1007/s12026-013-8407-x · Cited by 57 · see citing works
Medina, G., Briones-García, E., Cruz-Domínguez, M. P., Florez-Durante, Ó. I., & Jara, L. J. (2017) · Autoimmunity Reviews · doi:10.1016/j.autrev.2017.02.004 · Cited by 48 · see citing works
Leone, A., Radin, M., Almarzooqi, A. M., et al. (2017) · Autoimmunity Reviews · doi:10.1016/j.autrev.2017.03.008 · Cited by 44 · see citing works
Criado-García, J., Fernandez‐Puebla, R. A., Jiménez, L. L., et al. (2008) · Revista Clínica Española · doi:10.1157/13115821 · Cited by 41 · see citing works
Sciascia, S., Rubini, E., Radin, M., et al. (2018) · Annals of the Rheumatic Diseases · doi:10.1136/annrheumdis-2018-213496 · Cited by 41 · see citing works
Cessation of oral anticoagulants in antiphospholipid syndrome
Comarmond, C., Jégo, P., Veyssier-Belot, C., Marié, I., MEKINIAN, A., Elmaleh-Sachs, A., Leroux, G., Saadoun, D., Oziol, E., Fraisse, T., et al. (2017) · Lupus · doi:10.1177/0961203317699285 · Cited by 39 · see citing works
Belizna, C. C., Stojanovich, L., Tervaert, J. W. C., Fassot, C., Henrion, D., Loufrani, L., Nagy, G., Muchardt, C., Hasan, M., Ungeheuer, M. N., et al. (2018) · Autoimmunity Reviews · doi:10.1016/j.autrev.2018.01.027 · Cited by 34 · see citing works
Anticoagulation withdrawal in antiphospholipid syndrome: a retrospective matched-control study
Yelnik, C., Urbanski, G., Drumez, É., Caron, C., Maillard, H., Morell‐Dubois, S., Dubucquoi, S., Launay, D., HACHULLA, E., Hatron, P., et al. (2017) · Lupus · doi:10.1177/0961203317721751 · Cited by 18 · see citing works
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Lupus anticoagulant test persistence over time and its associations with future thrombotic events
Colling, M. E., Ay, C., Kraemmer, D., Koder, S., Quehenberger, P., Pabinger, I., Posch, F., & Gebhart, J. (2022) · Blood Advances · doi:10.1182/bloodadvances.2021006011 · Cited by 5 · see citing works
“This corresponded to 10-year prospective ATE, VTE, and overall thrombosis incidences of 14% (95%CI: 9-21), 20% (13-28), and 34% (26-43), respectively, and a 10-year mortality of 14% (9-22) (supplemental Figure 2).”
Background
- Authors
- Zen, M., Loredo Martinez, M., Benvenuti, F., Gatto, M., Saccon, F., Larosa, M., Iaccarino, L., & Doria, A.
- Affiliations
- University of Padua (IT)
- Division of Rheumatology, Lozano Blesa University Clinical Hospital, Zaragoza, Spain
- Corresponding author
- Doria, Andrea
- ORCID
- Venue
- Rheumatology
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-09-17
- Volume
- 60
- Issue
- 3
- Pages
- 1313-1320
- ISSN
- 1462-0324 (ISSN-L)
- 1462-0332
- OpenAlex
- W3087560814
- Cited by
- 19
- References
- 22
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 3
- FWCI
- 2.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Lara D. Veeken (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Funders
- Ethics Committee of the ‘Azienda Ospedaliera- Università degli Studi di Padova’
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vasculitis and related conditions
- Health Sciences › Medicine › Pathology and Forensic Medicine › Systemic Sclerosis and Related Diseases
- Keywords
- systemic lupus erythematosus, secondary antiphospholipid syndrome, thrombosis, lupus anticoagulant, anticardiolipin antibodies, anti-beta2-glycoprotein I antibodies, immunosuppressive therapy, thrombosis risk factors, recurrent thrombosis
- MeSH terms
- Anticoagulants, Female, Humans, Lupus Erythematosus, Systemic, Male, Middle Aged, Retrospective Studies, Thrombosis, Prevalence, Antiphospholipid Syndrome, Treatment Outcome, Antibodies, Antiphospholipid
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