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Signorelli F, Balbi GGM, Aikawa NE, Silva CA, Kupa LDVK, Medeiros-Ribeiro AC, Yuki EF, Pasoto SG, Saad CG, Borba EF, Seguro LPC, Pedrosa T, Oliveira VADA, Costa ALCDS, Ribeiro CT, Santos REB, Andrade DCO, Bonfá E. Immunogenicity, safety, and antiphospholipid antibodies after SARS-CoV-2 vaccine in patients with primary antiphospholipid syndrome. Lupus 2022; 31:974-984. [PMID: 35593174 PMCID: PMC9127455 DOI: 10.1177/09612033221102073] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective Coronavirus disease 19 (COVID-19) has an increased risk of coagulopathy with high frequency of antiphospholipid antibodies (aPL). Recent reports of thrombosis associated with adenovirus-based vaccines raised concern that SARS-CoV-2 immunization in primary antiphospholipid syndrome (PAPS) patients may trigger clotting complications. Our objectives were to assess immunogenicity, safety, and aPL production in PAPS patients, after vaccinating with Sinovac-CoronaVac, an inactivated virus vaccine against COVID-19. Methods This prospective controlled phase-4 study of PAPS patients and a control group (CG) consisted of a two-dose Sinovac-CoronaVac (D0/D28) and blood collection before vaccination (D0), at D28 and 6 weeks after second dose (D69) for immunogenicity/aPL levels. Outcomes were seroconversion (SC) rates of anti-SARS-CoV-2 S1/S2 IgG and/or neutralizing antibodies (NAb) at D28/D69 in naïve participants. Safety and aPL production were also assessed. Results We included 44 PAPS patients (31 naïve) and 132 CG (108 naïve) with comparable age (p=0.982) and sex (p>0.999). At D69, both groups had high and comparable SC (83.9% vs. 93.5%, p=0.092), as well as NAb positivity (77.4% vs. 78.7%, p=0.440), and NAb-activity (64.3% vs. 60.9%, p=0.689). Thrombotic events up to 6 months or other moderate/severe side effects were not observed. PAPS patients remained with stable aPL levels throughout the study at D0 vs. D28 vs. D69: anticardiolipin (aCL) IgG (p=0.058) and IgM (p=0.091); anti-beta-2 glycoprotein I (aβ2GPI) IgG (p=0.513) and IgM (p=0.468). Conclusion We provided novel evidence that Sinovac-CoronaVac has high immunogenicity and safety profile in PAPS. Furthermore, Sinovac-CoronaVac did not trigger thrombosis nor induced changes in aPL production.
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Affiliation(s)
- Flavio Signorelli
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, 117265Universidade de São Paulo, Brazil.,Rheumatology Division, Hospital Universitário Pedro Ernesto, 28130Universidade do Estado do Rio de Janeiro, Brazil
| | - Gustavo Guimarães Moreira Balbi
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, 117265Universidade de São Paulo, Brazil.,Rheumatology Division, Hospital Universitário, 424848Universidade Federal de Juiz de Fora, Brazil
| | - Nadia E Aikawa
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Léonard de Vinci Kanda Kupa
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, 117265Universidade de São Paulo, Brazil
| | - Ana C Medeiros-Ribeiro
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, 117265Universidade de São Paulo, Brazil
| | - Emily Fn Yuki
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, 117265Universidade de São Paulo, Brazil
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, 117265Universidade de São Paulo, Brazil
| | - Carla Gs Saad
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, 117265Universidade de São Paulo, Brazil
| | - Eduardo F Borba
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, 117265Universidade de São Paulo, Brazil
| | - Luciana Parente Costa Seguro
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, 117265Universidade de São Paulo, Brazil
| | - Tatiana Pedrosa
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, 117265Universidade de São Paulo, Brazil
| | | | | | - Carolina T Ribeiro
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, 117265Universidade de São Paulo, Brazil
| | - Roseli Eliana Beseggio Santos
- Central Laboratory Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, 117265Universidade de São Paulo, Brazil
| | | | - Eloisa Bonfá
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, 117265Universidade de São Paulo, Brazil
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Medina G, Cimé Aké EA, Vera-Lastra O, Saavedra MÁ, Cruz-Domínguez MDP, Amigo MC, Jara LJ. Damage index for antiphospholipid syndrome during long term follow-up: Correlation between organ damage accrual and quality of life. Lupus 2020; 30:96-102. [PMID: 33176566 DOI: 10.1177/0961203320970651] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Consequences of organ damage in primary antiphospholipid syndrome (PAPS) are diverse, our aim was to determine organ damage over time and the correlation of organ damage accrual with health-related quality of life (HRQoL) in PAPS. METHODS First phase: retrospective cohort applying Damage Index for Antiphospholipid Syndrome (DIAPS) at 1, 5, 10, 20 years, or longer since diagnosis. Second phase: cross-sectional study, assessing HRQoL by the Medical Outcomes Study Short Form 36 (SF-36), and organ damage accrual. Descriptive statistics and Spearman correlation coefficient were used. RESULTS Sixty-seven patients were included, mean follow-up:15 years. Deep vein thrombosis prevailed (71.6%), pulmonary embolism (35.8%) and stroke (32.8%). Organ damage was found in 98.5%, with a cumulative DIAPS value of 3, with greater involvement in the neuropsychiatric and peripheral vascular domains. Regarding HRQoL, deterioration in the physical component summary (PCS) was found in 89.6%. Organ damage accrual correlated inversely and significantly with all the SF-36 domains, mainly with the total score and PCS. Body pain and PCS correlated the most (rho = -0.503, rho = -0.475). CONCLUSIONS Organ damage accrual impaired HRQoL in PAPS. Secondary thromboprophylxis through adequate systemic management and control of cardiovascular risk factors are necessary to prevent further impairment.
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Affiliation(s)
- Gabriela Medina
- Translational Research Unit, Hospital de Especialidades Centro Médico La Raza, IMSS, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Erik Antonio Cimé Aké
- Internal Medicine Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Olga Vera-Lastra
- Internal Medicine Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Miguel Ángel Saavedra
- Rheumatology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - María Del Pilar Cruz-Domínguez
- Research Division, Hospital de Especialidades Centro Médico La Raza, IMSS, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Luis J Jara
- Direction of Education and Research, Hospital de Especialidades Centro Médico La Raza, IMSS, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Balbi GGM, Pacheco MDS, Monticielo OA, Funke A, Danowski A, Santiago MB, Staub HL, Rêgo J, de Andrade DCO. Antiphospholipid Syndrome Committee of the Brazilian Society of Rheumatology position statement on the use of direct oral anticoagulants (DOACs) in antiphospholipid syndrome (APS). Adv Rheumatol 2020; 60:29. [PMID: 32460902 DOI: 10.1186/s42358-020-00125-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The term Direct Oral Anticoagulants (DOACs) refers to a group of drugs that inhibit factor Xa or thrombin. Even though their use for treating different thrombotic or prothrombotic conditions is increasing recently, there is no compelling evidence indicating that those medications are safe in all antiphospholipid syndrome (APS) patients. METHODOLOGY To address this issue, specialists from the Antiphospholipid Syndrome Committee of the Brazilian Society of Rheumatology performed a comprehensive review of the literature regarding DOACs use in APS to answer the three following questions: (1) potential mechanisms of action of these drugs that could be relevant to APS pathogenesis, (2) DOACs interference on lupus anticoagulant testing, and (3) the efficacy of DOACs in APS. POSITION STATEMENT After critically reviewing the relevant evidence, the authors formulated 8 Position Statements about DOACs use in APS. CONCLUSION DOACs should not be routinely used in APS patients, especially in those with a high-risk profile (triple positivity to aPL, arterial thrombosis, and recurrent thrombotic events). In addition, DOACs interferes with LA testing, leading to false-positive results in patients investigating APS.
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Affiliation(s)
- Gustavo Guimarães Moreira Balbi
- Serviço de Reumatologia, Hospital Universitário, Universidade Federal de Juiz de Fora (UFJF), Av. Eugênio do Nascimento, s/n - Dom Bosco, Juiz de Fora, MG, 36038-330, Brazil.
| | - Marcelo de Souza Pacheco
- Serviço de Reumatologia, Hospital Federal dos Servidores do Estado (HFSE), Rio de Janeiro, RJ, Brazil
| | - Odirlei Andre Monticielo
- Serviço de Reumatologia, Departamento de Medicina Interna, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFGRS), Porto Alegre, RS, Brazil
| | - Andreas Funke
- Serviço de Reumatologia, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Adriana Danowski
- Serviço de Reumatologia, Hospital Federal dos Servidores do Estado (HFSE), Rio de Janeiro, RJ, Brazil
| | - Mittermayer Barreto Santiago
- Serviço de Reumatologia, Universidade Federal da Bahia (HUPES) e Escola Baiana de Medicina e Saúde Pública, Salvador, BA, Brazil
| | - Henrique Luiz Staub
- Serviço de Reumatologia, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Jozelia Rêgo
- Serviço de Reumatologia, Faculdade de Medicina, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil
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Vadgama TS, Smith A, Bertolaccini ML. Treatment in thrombotic antiphospholipid syndrome: a review. Lupus 2019; 28:1181-1188. [PMID: 31345117 DOI: 10.1177/0961203319864163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Antiphospholipid syndrome an autoimmune disease characterized by thrombosis and/or pregnancy morbidity alongside the presence of antiphospholipid antibodies (aPL). This review evaluates primary and secondary thromboprophylaxis in patients with aPL and thrombotic events. In primary thromboprophylaxis a risk-stratified approach is needed based on aPL, comorbidity with other autoimmune conditions and cardiovascular vascular risk factors. In primary thromboprophylaxis, the efficacy of low-dose aspirin is debatable and requires better-designed controlled studies. So far warfarin has not been shown to improve venous and/or arterial thrombosis incidence in aPL carriers and instead increased safety concerns. The benefit of hydroxychloroquine is inconclusive despite promising data, requiring large, controlled trials. For secondary thromboprophylaxis warfarin seems to be the best option with potential in renal transplant recipients and better efficacy at high intensity, although maintenance of target international normalized ratio needs careful monitoring. Aspirin has not shown to be beneficial, and data on rivaroxaban are limited and contradictory. Despite all data being informative, there are limitations that need to be addressed with robust clinical trials.
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Affiliation(s)
- T S Vadgama
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine & Sciences, King's College London, St Thomas' Hospital, London, UK
| | - A Smith
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine & Sciences, King's College London, St Thomas' Hospital, London, UK
| | - M L Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine & Sciences, King's College London, St Thomas' Hospital, London, UK
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Fleetwood T, Cantello R, Comi C. Antiphospholipid Syndrome and the Neurologist: From Pathogenesis to Therapy. Front Neurol 2018; 9:1001. [PMID: 30534110 PMCID: PMC6275383 DOI: 10.3389/fneur.2018.01001] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/06/2018] [Indexed: 12/16/2022] Open
Abstract
Antiphospholipid syndrome (APS) is an autoimmune antibody-mediated condition characterized by thrombotic events and/or pregnancy morbidity in association with persistent positivity to antiphospholipid antibodies (aPL). The nervous system is frequently affected, as intracranial vessels are the most frequent site of arterial pathology. Over the course of years, many other neurological conditions not included in the diagnostic criteria, have been associated with APS. The pathogenic mechanisms behind the syndrome are complex and not fully elucidated. aPL enhance thrombosis, interfering with different pathways. Nevertheless, ischemic injury is not always sufficient to explain clinical features of the syndrome and immune-mediated damage has been advocated. This may be particularly relevant in the context of neurological complications. The reason why only a subgroup of patients develop non-criteria nervous system disorders and what determines the clinical phenotype are questions that remain open. The double nature, thrombotic and immunologic, of APS is also reflected by therapeutic strategies. In this review we summarize known neurological manifestations of APS, revisiting pathogenesis and current treatment options.
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Affiliation(s)
- Thomas Fleetwood
- Section of Neurology, Department of Translational Medicine University of Eastern Piedmont, Novara, Italy
| | - Roberto Cantello
- Section of Neurology, Department of Translational Medicine University of Eastern Piedmont, Novara, Italy
| | - Cristoforo Comi
- Section of Neurology, Department of Translational Medicine University of Eastern Piedmont, Novara, Italy.,Interdisciplinary Research Centre of Autoimmune Diseases University of Eastern Piedmont, Novara, Italy
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