EUREKA algorithm predicts obstetric risk and response to treatment in women with different subsets of anti-phospholipid antibodies.
- 1. Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy, 2Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy, 3Division of Rheumatology, ASST G. Pini & CTO, Milan, Italy, 4Department of Obstetrics and Gynaecology, Fondazione Ca` Granda, Ospedale Maggiore Policlinico, Milan, Italy and 5Immunology and Rheumatology Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
Description
Abstract
Objectives. aPL, the serum biomarkers of APS, are the most common acquired causes of pregnancy morbidity
(PM). This study investigates the impact of aPL positivity fulfilling classification criteria (‘criteria aPL’) and at titres
lower than thresholds considered by classification criteria (‘low-titre aPL’) on PM and assesses the effectiveness of
low-dose aspirin (LDASA), low molecular weight heparin (LMWH) and HCQ in reducing the probability of PM (PPM).
Methods. Longitudinal data on 847 pregnancies in 155 women with persistent aPL at any titre and 226 women
with autoimmune diseases and negative aPL were retrospectively collected. A generalized estimating equations
model for repeated measures was applied to quantify PPM under different clinical situations.
Results. EUREKA is a novel algorithm that accurately predicts the risk of aPL-associated PM by considering aPL
titres and profiles. aPL significantly impact PPM when at low titres and when fulfilling classification criteria. PPM was
further stratified upon the aPL tests: aCL IgG/IgM and anti-b2-glycoprotein I (b2GPI) IgM, alone or combined, do
not affect the basal risks of PPM, an increase occurs in case of positive LA or anti-b2GPI IgG. LDASA significantly
affects PPM exclusively in women with low-titre aPL without anti-b2GPI IgG. The LDASAþLMWH combination significantly
reduces PPM in all women with low-titre aPL and women with criteria aPL, except those carrying LA and
anti-b2GPI IgG. In this group, the addition of HCQ further reduces PPM, although not significantly.
Conclusion. EUREKA allows a tailored therapeutic approach, impacting everyday clinical management of aPLpositive
pregnant women.
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