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Yelnik CM, Erton ZB, Drumez E, Cheildze D, de Andrade D, Clarke A, Tektonidou MG, Sciascia S, Pardos-Gea J, Pengo V, Ruiz-Irastorza G, Belmont HM, Pedrera CL, Fortin PR, Wahl D, Gerosa M, Kello N, Signorelli F, Atsumi T, Ji L, Efthymiou M, Branch DW, Nalli C, Rodriguez-Almaraz E, Petri M, Cervera R, Shi H, Zuo Y, Artim-Esen B, Pons-Estel G, Willis R, Barber MRW, Skeith L, Bertolaccini ML, Cohen H, Roubey R, Erkan D. Thrombosis recurrence and major bleeding in non-anticoagulated thrombotic antiphospholipid syndrome patients: Prospective study from antiphospholipid syndrome alliance for clinical trials and international networking (APS ACTION) clinical database and repository ("Registry"). Semin Arthritis Rheum 2024; 65:152347. [PMID: 38185079 DOI: 10.1016/j.semarthrit.2023.152347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/13/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Long-term anticoagulant therapy is generally recommended for thrombotic antiphospholipid syndrome (TAPS) patients, however it may be withdrawn or not introduced in routine practice. OBJECTIVES To prospectively evaluate the risk of thrombosis recurrence and major bleeding in non-anticoagulated TAPS patients, compared to anticoagulated TAPS, and secondly, to identify different features between those two groups. PATIENTS/METHODS Using an international registry, we identified non-anticoagulated TAPS patients at baseline, and matched them with anticoagulated TAPS patients based on gender, age, type of previous thrombosis, and associated autoimmune disease. Thrombosis recurrence and major bleeding were prospectively analyzed using Kaplan-Meier method and compared using a marginal Cox's regression model. RESULTS As of June 2022, 94 (14 %) of the 662 TAPS patients were not anticoagulated; and 93 of them were matched with 181 anticoagulated TAPS patients (median follow-up 5 years [interquartile range 3 to 8]). The 5-year thrombosis recurrence and major bleeding rates were 12 % versus 10 %, and 6 % versus 7 %, respectively (hazard ratio [HR] 1.38, 95 % confidence interval [CI] 0.53 to 3.56, p = 0.50 and HR 0.53; 95 % CI 0.15 to 1.86; p = 0.32, respectively). Non-anticoagulated patients were more likely to receive antiplatelet therapy (p < 0.001), and less likely to have more than one previous thrombosis (p < 0.001) and lupus anticoagulant positivity (p = 0.01). CONCLUSION Fourteen percent of the TAPS patients were not anticoagulated at recruitment. Their recurrent thrombosis risk did not differ compared to matched anticoagulated TAPS patients, supporting the pressing need for risk-stratified secondary thrombosis prevention trials in APS investigating strategies other than anticoagulation.
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Affiliation(s)
- Cecile M Yelnik
- Univ. Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, INSERM, UMR 1167, F-59000 Lille, France.
| | | | - Elodie Drumez
- Univ. Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, INSERM, UMR 1167, F-59000 Lille, France
| | - Dachi Cheildze
- Hospital for Special Surgery, New York, NY, USA; Yale New Haven Hospital, New Haven, CT, USA
| | | | - Ann Clarke
- University of Calgary, Calgary, Alberta, Canada
| | | | | | | | | | | | | | | | - Paul R Fortin
- Centre ARThrite - CHU de Québec- Université Laval, Quebec, QC, Canada
| | - Denis Wahl
- Université de Lorraine, Inserm DCAC, and CHRU-Nancy, Nancy, France
| | | | - Nina Kello
- Northwell Health, New Hyde Park, NY, USA
| | | | | | - Lanlan Ji
- Peking University First Hospital, Beijing, China
| | | | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | | | | | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Hui Shi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zuo
- University of Michigan, Ann Arbor, MI, USA
| | | | - Guillermo Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas del Grupo Oroño (GO-CREAR), Rosario, Argentina
| | - Rohan Willis
- University of Texas Medical Branch, Galveston, TX, USA
| | | | | | | | - Hannah Cohen
- University College London, London, United Kingdom
| | | | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
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Balbi GGM, Ahmadzadeh Y, Tektonidou MG, Pengo V, Sciascia S, Ugarte A, Belmont HM, Lopez-Pedrera C, Fortin PR, Wahl D, Gerosa M, de Jesús GR, Ji L, Atsumi T, Efthymiou M, Branch DW, Nalli C, Rodriguez Almaraz E, Petri M, Cervera R, Knight JS, Artim-Esen B, Willis R, Bertolaccini ML, Cohen H, Roubey R, Erkan D, de Andrade DCO. Damage measured by Damage Index for Antiphospholipid Syndrome (DIAPS) in antiphospholipid antibody-positive patients included in the APS ACTION registry. Rheumatology (Oxford) 2024; 63:772-779. [PMID: 37307082 DOI: 10.1093/rheumatology/kead292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVES Our primary objective was to quantify damage burden measured by Damage Index for Antiphospholipid Syndrome (DIAPS) in aPL-positive patients with or without a history of thrombosis in an international cohort (the APS ACTION cohort). Secondly, we aimed to identify clinical and laboratory characteristics associated with damage in aPL-positive patients. METHODS In this cross-sectional study, we analysed the baseline damage in aPL-positive patients with or without APS classification. We excluded patients with other autoimmune diseases. We analysed the demographic, clinical and laboratory characteristics based on two subgroups: (i) thrombotic APS patients with high vs low damage; and (ii) non-thrombotic aPL-positive patients with vs without damage. RESULTS Of the 826 aPL-positive patients included in the registry as of April 2020, 586 with no other systemic autoimmune diseases were included in the analysis (412 thrombotic and 174 non-thrombotic). In the thrombotic group, hyperlipidaemia (odds ratio [OR] 1.82; 95% CI 1.05, 3.15; adjusted P = 0.032), obesity (OR 2.14; 95% CI 1.23, 3.71; adjusted P = 0.007), aβ2GPI high titres (OR 2.33; 95% CI 1.36, 4.02; adjusted P = 0.002) and corticosteroid use (ever) (OR 3.73; 95% CI 1.80, 7.75; adjusted P < 0.001) were independently associated with high damage at baseline. In the non-thrombotic group, hypertension (OR 4.55; 95% CI 1.82, 11.35; adjusted P = 0.001) and hyperlipidaemia (OR 4.32; 95% CI 1.37, 13.65; adjusted P = 0.013) were independent predictors of damage at baseline; conversely, single aPL positivity was inversely correlated with damage (OR 0.24; 95% CI 0.075, 0.77; adjusted P = 0.016). CONCLUSIONS DIAPS indicates substantial damage in aPL-positive patients in the APS ACTION cohort. Selected traditional cardiovascular risk factors, steroids use and specific aPL profiles may help to identify patients more prone to present with a higher damage burden.
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Affiliation(s)
- Gustavo G M Balbi
- Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Yasaman Ahmadzadeh
- Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, University of Turin, Turin, Italy
| | - Amaia Ugarte
- Hospital Universitario Cruces, País Vasco, Barakaldo, Spain
| | | | - Chary Lopez-Pedrera
- Rheumatology Service, IMIBIC/Reina Sofia Hospital, University of Cordoba, Cordoba, Spain
| | - Paul R Fortin
- CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Denis Wahl
- Université de Lorraine, INSERM, DCAC, Nancy, France
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, CHRU-Nancy, Nancy, France
| | - Maria Gerosa
- Clinical Immunology & Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Lanlan Ji
- Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
| | | | - Maria Efthymiou
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | - Cecilia Nalli
- Rheumatology and Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | | | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, TX, USA
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | | | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
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Chighizola CB, Willis R, Maioli G, Sciascia S, Andreoli L, Amengual O, Radin M, Gerosa M, Atsumi T, de Jesus G, Trespidi L, Branch DW, Caporali R, Andrade D, Roubey R, Petri M, Bertolaccini ML. Deciphering the clinical significance of longitudinal antiphospholipid antibody titers. Autoimmun Rev 2024; 23:103510. [PMID: 38171447 DOI: 10.1016/j.autrev.2023.103510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024]
Abstract
In antiphospholipid syndrome (APS), the risk of clinical manifestations increases with higher titers of antiphospholipid antibodies (aPL). Despite the adoption of aPL titers in the classification approach to aPL-positive subjects, the value of longitudinal monitoring of those titers in the follow-up is still debated, being well studied only in systemic lupus erythematosus (SLE). The literature suggests that the rate of aPL positivity decreases during follow-up in primary APS, estimating that seroconversion occurs in between 8.9 and 59% of patients over time. Negativisation of aPL occurs more frequently in asymptomatic aPL carriers than in patients with full-blown APS as well as in subjects with single aPL positivity or low aPL antibody titers. In patients with SLE, aPL typically behave fluctuating from positive to negative and back again in the course of follow-up. The few studies assessing the longitudinal course of aPL positivity with no associated systemic connective tissue disease reported a progressive decrement of aPL titers over time, in particular of antibodies against β2 glycoprotein I (antiβ2GPI) and cardiolipin (aCL) of IgG isotype. After a thrombotic event, aPL titers tend to decrease, as emerged from cohorts of both primary and secondary APS. Hydroxychloroquine has been identified as the most effective pharmacological agent to reduce aPL titers, with multiple studies demonstrating a parallel reduction in thrombosis rate. This review addresses available evidence on the significance of aPL titer fluctuation from clinical, therapeutic and pathogenic perspectives.
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Affiliation(s)
- Cecilia B Chighizola
- Department of Clinical Sciences and Community Health, University of Milan, Pediatric Rheumatology Unit, ASST G. Pini - CTO, Milan, Italy.
| | - Rohan Willis
- University of Texas Medical Branch, Internal Medicine, Galveston, USA
| | - Gabriella Maioli
- Department of Clinical Sciences and Community Health, University of Milan, Clinical Rheumatology Unit, ASST G. Pini - CTO, Milan, Italy
| | - Savino Sciascia
- University of Turin, Department of Clinical and Biological Sciences, Turin, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Olga Amengual
- Hokkaido University, Department of Rheumatology, Endocrinology and Nephrology Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Massimo Radin
- University of Turin, Department of Clinical and Biological Sciences, Turin, Italy
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, University of Milan, Clinical Rheumatology Unit, ASST G. Pini - CTO, Milan, Italy
| | - Tatsuya Atsumi
- Hokkaido University, Department of Rheumatology, Endocrinology and Nephrology Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Guilherme de Jesus
- Universidade do Estado do Rio de Janeiro, Department of Obstetrics, Rio de Janeiro, Brazil
| | - Laura Trespidi
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - D Ware Branch
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Pediatric Rheumatology Unit, ASST G. Pini - CTO, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Clinical Rheumatology Unit, ASST G. Pini - CTO, Milan, Italy
| | | | - Robert Roubey
- Department of Rheumatology, University of North Carolina, Chapel Hill, NC, USA
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Rheumatology, Baltimore, MD, USA
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Atsumi T, Chighizola CB, Fujieda Y, Mackie I, Radin M, Roubey R, Bertolaccini ML. 16th International congress on antiphospholipid antibodies task force report on antiphospholipid syndrome laboratory diagnostics and trends. Lupus 2023; 32:1625-1636. [PMID: 37933818 PMCID: PMC10666497 DOI: 10.1177/09612033231211820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Classification criteria for antiphospholipid syndrome (APS) require IgG or IgM isotypes of the anticardiolipin (aCL) antibodies, anti-β2 glycoprotein I (anti-β2GPI) antibodies, and/or the lupus anticoagulant (LA) to satisfy the laboratory disease definition. Over the past 20 years, non-criteria antiphospholipid antibodies (aPL) directed to other proteins of the coagulation cascade (i.e. prothrombin and/or phosphatidylserine-prothrombin complex) or to some domains of β2GPI have been proposed. This task force concentrated and reviewed the literature on data including aPS/PT, antibodies to domain 4/5 of β2GPI and the newly described antibodies to protein/HLA-DR complex. In addition, we discussed testing of LA in the 'new' oral anticoagulants' era and the value of triple positivity in the risk assessment of aPL. The conclusions were presented at a special session during the 16th International Congress on aPL, Manchester, UK, September 2019.
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Affiliation(s)
- Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Cecilia B Chighizola
- Unit of Pediatric Rheumatology, ASST G. Pini - CTO, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Yuichiro Fujieda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Ian Mackie
- Department of Haematology, Haemostasis Research Unit, University College London, London, UK
| | - Massimo Radin
- Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Center of Research of Immunopathology and Rare Diseases - Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Turin, Italy
| | - Robert Roubey
- Division of Rheumatology, Allergy & Immunology, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK
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5
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Barbhaiya M, Zuily S, Naden R, Hendry A, Manneville F, Amigo MC, Amoura Z, Andrade D, Andreoli L, Artim-Esen B, Atsumi T, Avcin T, Belmont HM, Bertolaccini ML, Branch DW, Carvalheiras G, Casini A, Cervera R, Cohen H, Costedoat-Chalumeau N, Crowther M, de Jesus G, Delluc A, Desai S, De Sancho M, Devreese KM, Diz-Kucukkaya R, Duarte-Garcia A, Frances C, Garcia D, Gris JC, Jordan N, Leaf RK, Kello N, Knight JS, Laskin C, Lee AI, Legault K, Levine SR, Levy RA, Limper M, Lockshin MD, Mayer-Pickel K, Musial J, Meroni PL, Orsolini G, Ortel TL, Pengo V, Petri M, Pons-Estel G, Gomez-Puerta JA, Raimboug Q, Roubey R, Sanna G, Seshan SV, Sciascia S, Tektonidou MG, Tincani A, Wahl D, Willis R, Yelnik C, Zuily C, Guillemin F, Costenbader K, Erkan D. The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria. Arthritis Rheumatol 2023; 75:1687-1702. [PMID: 37635643 DOI: 10.1002/art.42624] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/14/2023] [Accepted: 05/30/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR. METHODS This international multidisciplinary initiative included 4 phases: 1) Phase I, criteria generation by surveys and literature review; 2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; 3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and 4) Phase IV, validation using independent adjudicators' consensus as the gold standard. RESULTS The 2023 ACR/EULAR APS classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1-7 points each) clustered into 6 clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and 2 laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti-β2 -glycoprotein I antibodies). Patients accumulating at least 3 points each from the clinical and laboratory domains are classified as having APS. In the validation cohort, the new APS criteria versus the 2006 revised Sapporo classification criteria had a specificity of 99% versus 86%, and a sensitivity of 84% versus 99%. CONCLUSION These new ACR/EULAR APS classification criteria were developed using rigorous methodology with multidisciplinary international input. Hierarchically clustered, weighted, and risk-stratified criteria reflect the current thinking about APS, providing high specificity and a strong foundation for future APS research.
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Affiliation(s)
- Medha Barbhaiya
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Stephane Zuily
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France
| | - Ray Naden
- Department of Medicine and Obstetrics, Auckland City Hospital, Auckland, New Zealand
| | - Alison Hendry
- Department of General Medicine, Middlemore Hospital, Counties Manukau Health District, Auckland, New Zealand
| | - Florian Manneville
- CIC Clinical epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Mary-Carmen Amigo
- Department of Internal Medicine, Service of Rheumatology, ABC Medical Center, Mexico DF, Mexico
| | - Zahir Amoura
- French National Reference Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome, Service de Medecine Interne 2, Hopital Pitie-Salpetriére; Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universite, Paris, France
| | - Danieli Andrade
- Department of Rheumatology, University of Sao Paulo, Sao Paulo, Brazil
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Bahar Artim-Esen
- Department of Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology, and Nephrology, Hokkaido University, Sapporo, Japan
| | - Tadej Avcin
- Department of Allergology, Rheumatology, and Clinical Immunology, Children's Hospital, University Medical Center, University of Ljubljana, Ljubljana, Slovenia
| | - H Michael Belmont
- Department of Rheumatology, Hospital for Joint Disease, New York University, New York, New York
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College, London, UK
| | - D Ware Branch
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Graziela Carvalheiras
- Unidade de Imunologia Clínica, Departamento de Medicina Interna, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Alessandro Casini
- Division of Angiology and Hemostasis, University Hospital of Geneva, Geneva, Switzerland
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Hannah Cohen
- Department of Haematology, University College London, London, UK
| | - Nathalie Costedoat-Chalumeau
- Service de médecine interne, Centre de reference maladies autoimmunes et systémiques rares Île de France, APHP, Hopital Cochin, Université de Paris, Centre de recherche épidémiologie et biostatistiques de Sorbonne Paris Cité, F-75004 Paris, France
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Guilherme de Jesus
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aurelien Delluc
- Department of Medicine, University Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sheetal Desai
- Division of Rheumatology, University of California, Irvine, California
| | - Maria De Sancho
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York
| | - Katrien M Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, and Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Reyhan Diz-Kucukkaya
- Department of Molecular Biology and Genetics, Istanbul University School of Science, Istanbul, Turkey
| | | | - Camille Frances
- Department of Dermatology-Allergology, Tenon Hospital, Paris, France
| | - David Garcia
- Department of Hematology, University of Washington, Seattle, Washington
| | - Jean-Christophe Gris
- Department of Hematology, CHRU-Nimes, UMR UA11 INSERM-University of Montpellier, France
| | - Natasha Jordan
- Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK
| | - Rebecca K Leaf
- Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nina Kello
- Division of Rheumatology, Northwell Health, Great Neck, New York
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan
| | - Carl Laskin
- Division of Rheumatology, University of Toronto, TRIO Fertility, Toronto, Canada
| | - Alfred I Lee
- Department of Hematology, Yale School of Medicine, New Haven, Connecticut
| | - Kimberly Legault
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada
| | - Steve R Levine
- Downstate Stroke Center, State University of New York Downstate Health Sciences University, Kings County Hospital Center, and Maimonides Medical Center/Jaffe Stroke Center, Brooklyn, New York
| | - Roger A Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil, and GlaxoSmithKline, Collegeville, Pennsylvania
| | - Maarten Limper
- Department of Medicine and Clinical Immunology, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Michael D Lockshin
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | - Jack Musial
- Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Thomas L Ortel
- Division of Hematology, Duke University Medical Center, Durham, North Carolina
| | - Vittorio Pengo
- Department of Cardiology, University Hospital, Padova, Italy
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Guillermo Pons-Estel
- Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | | | - Quentin Raimboug
- Department of Nephrology, Bichat University Hospital, Paris, France
| | - Robert Roubey
- Department of Rheumatology, University of North Carolina, Chapel Hill, North Carolina
| | - Giovanni Sanna
- Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Surya V Seshan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy, and University of Turin, Torino, Italy
| | - Maria G Tektonidou
- Joint Academic Rheumatology Program, First Propaedeutic and Internal Medicine Program, National and Kapodistrian University of Athens, Athens, Greece
| | - Angela Tincani
- Department of Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Denis Wahl
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France
| | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, Texas
| | - Cecile Yelnik
- Department of Internal Medicine and Immunology, Université de Lille, CHU Lille, INSERM, UMR 1167, F-59000 Lille, France
| | - Catherine Zuily
- Department of Obstetrics, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France
| | - Francis Guillemin
- CIC Clinical epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Karen Costenbader
- Department of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
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Barbhaiya M, Zuily S, Naden R, Hendry A, Manneville F, Amigo MC, Amoura Z, Andrade D, Andreoli L, Artim-Esen B, Atsumi T, Avcin T, Belmont HM, Bertolaccini ML, Branch DW, Carvalheiras G, Casini A, Cervera R, Cohen H, Costedoat-Chalumeau N, Crowther M, de Jesús G, Delluc A, Desai S, Sancho MD, Devreese KM, Diz-Kucukkaya R, Duarte-García A, Frances C, Garcia D, Gris JC, Jordan N, Leaf RK, Kello N, Knight JS, Laskin C, Lee AI, Legault K, Levine SR, Levy RA, Limper M, Lockshin MD, Mayer-Pickel K, Musial J, Meroni PL, Orsolini G, Ortel TL, Pengo V, Petri M, Pons-Estel G, Gomez-Puerta JA, Raimboug Q, Roubey R, Sanna G, Seshan SV, Sciascia S, Tektonidou MG, Tincani A, Wahl D, Willis R, Yelnik C, Zuily C, Guillemin F, Costenbader K, Erkan D. 2023 ACR/EULAR antiphospholipid syndrome classification criteria. Ann Rheum Dis 2023; 82:1258-1270. [PMID: 37640450 DOI: 10.1136/ard-2023-224609] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR. METHODS This international multidisciplinary initiative included four phases: (1) Phase I, criteria generation by surveys and literature review; (2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; (3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and (4) Phase IV, validation using independent adjudicators' consensus as the gold standard. RESULTS The 2023 ACR/EULAR APS classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1-7 points each) clustered into six clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and two laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti-β2-glycoprotein I antibodies). Patients accumulating at least three points each from the clinical and laboratory domains are classified as having APS. In the validation cohort, the new APS criteria vs the 2006 revised Sapporo classification criteria had a specificity of 99% vs 86%, and a sensitivity of 84% vs 99%. CONCLUSION These new ACR/EULAR APS classification criteria were developed using rigorous methodology with multidisciplinary international input. Hierarchically clustered, weighted, and risk-stratified criteria reflect the current thinking about APS, providing high specificity and a strong foundation for future APS research.
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Affiliation(s)
- Medha Barbhaiya
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Stephane Zuily
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, Nancy, France
| | - Ray Naden
- Department of Medicine and Obstetrics, Auckland City Hospital, Auckland, New Zealand
| | - Alison Hendry
- Department of General Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Florian Manneville
- CIC Clinical Epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Mary-Carmen Amigo
- Department of Internal Medicine, Service of Rheumatology, ABC Medical Center, Mexico, Mexico
| | - Zahir Amoura
- French National Reference Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome, Service de Medecine Interne 2, Hopital Pitie-Salpetriére; Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universite, Paris, France
| | - Danieli Andrade
- Department of Rheumatology, University of Sao Paulo, Sao Paulo, Brazil
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Bahar Artim-Esen
- Department of Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology, and Nephrology, Hokkaido University, Sapporo, Japan
| | - Tadej Avcin
- Department of Allergology, Rheumatology, and Clinical Immunology, Children's Hospital, University Medical Center, University of Ljubljana, Ljubljana, Slovenia
| | - H Michael Belmont
- Department of Rheumatology, Hospital for Joint Disease, New York University, New York, New York, USA
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College, London, UK
| | - D Ware Branch
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, USA
| | - Graziela Carvalheiras
- Unidade de Imunologia Clínica, Departamento de Medicina Interna, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Alessandro Casini
- Division of Angiology and Hemostasis, University Hospital of Geneva, Geneva, Switzerland
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Hannah Cohen
- Department of Haematology, University College London, London, UK
| | - Nathalie Costedoat-Chalumeau
- Service de médecine interne, Centre de reference maladies autoimmunes et systémiques rares Île de France, APHP, Hopital Cochin, Université de Paris, Centre de recherche épidémiologie et biostatistiques de Sorbonne Paris Cité, Paris, France
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Guilherme de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aurelien Delluc
- Department of Medicine, University Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sheetal Desai
- Division of Rheumatology, University of California, Irvine, California, USA
| | - Maria De Sancho
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Katrien M Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Reyhan Diz-Kucukkaya
- Department of Molecular Biology and Genetics, Istanbul University School of Science, Istanbul, Turkey
| | | | - Camille Frances
- Department of Dermatology-Allergology, Tenon Hospital, Paris, France
| | - David Garcia
- Department of Hematology, University of Washington, Seattle, Washington, USA
| | - Jean-Christophe Gris
- Department of Hematology, CHRU-Nimes, UMR UA11 INSERM-University of Montpellier, Montpellier, France
| | - Natasha Jordan
- Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK
| | - Rebecca K Leaf
- Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nina Kello
- Division of Rheumatology, Northwell Health, Great Neck, New York, New York, USA
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Carl Laskin
- Division of Rheumatology, University of Toronto, TRIO Fertility, Toronto, Ontario, Canada
| | - Alfred I Lee
- Department of Hematology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly Legault
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada
| | - Steve R Levine
- Downstate Stroke Center, State University of New York Downstate Health Sciences University, Kings County Hospital Center, and Maimonides Medical Center/Jaffe Stroke Center, Brooklyn, New York, USA
| | - Roger A Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Maarten Limper
- Department of Medicine and Clinical Immunology, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Michael D Lockshin
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Jack Musial
- Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giovanni Orsolini
- Department of Rheumatology, University Hospitals of Verona, Verona, Italy
| | - Thomas L Ortel
- Division of Hematology, Duke University Medical Center, Durham, North Carolina, USA
| | - Vittorio Pengo
- Department of Cardiology, University Hospital, Padova, Italy
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Guillermo Pons-Estel
- Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | | | - Quentin Raimboug
- Department of Nephrology, Bichat University Hospital, Paris, France
| | - Robert Roubey
- Department of Rheumatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Giovanni Sanna
- Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Surya V Seshan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Savino Sciascia
- Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy
- University of Turin, Torino, Italy
| | - Maria G Tektonidou
- Joint Academic Rheumatology Program, First Propaedeutic and Internal Medicine Program, National and Kapodistrian University of Athens, Athens, Greece
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Denis Wahl
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, Nancy, France
| | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Cécile Yelnik
- Department of Internal Medicine and Immunology, Université de Lille, CHU Lille, INSERM, UMR 1167, Lille, France
| | - Catherine Zuily
- Department of Obstetrics, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, Nancy, France
| | - Francis Guillemin
- CIC Clinical Epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Karen Costenbader
- Department of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
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Gkrouzman E, Willis R, Andrade D, Tektonidou MG, Pengo V, Ruiz-Irastorza G, Belmont HM, Fortin PR, Gerosa M, Signorelli F, Atsumi T, Branch DW, Nalli C, Rodriguez-Almaraz E, Petri MA, Cervera R, Knight JS, Efthymiou M, Cohen H, Bertolaccini ML, Erkan D, Roubey R. Associations Among Antiphospholipid Antibody Types, Isotypes, and Titers: An AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Study. J Transl Med 2023; 103:100147. [PMID: 37044248 DOI: 10.1016/j.labinv.2023.100147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
Several antiphospholipid antibody (aPL) profiles ("triple" and lupus anticoagulant [LA] positivity) are associated with a higher risk for clinical manifestations of antiphospholipid syndrome (APS). Further risk is correlated with higher levels of anticardiolipin antibody (aCL) and anti-β2 glycoprotein-I antibody (aβ2GPI), and with aPL persistence. Given that the 3 aPL tests detect partially overlapping sets of antibodies, the primary goal of this study was to characterize the associations among aPL tests using AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) core laboratory data. The APS ACTION Registry includes annually followed adult patients with positive aPL based on the Revised Sapporo Classification Criteria. We analyzed baseline and prospective core laboratory data of the registry for associations among aPL tests using the Spearman rank correlation with Bonferroni-adjusted significance level for multiple comparisons. An aPL Load was calculated based on 6 tests (aCL IgG/IgM/IgA and aβ2GPI IgG/IgM/IgA); a receiver operating characteristic curve was used to evaluate the diagnostic performance of the aPL Load in predicting LA positivity. In 351 patients simultaneously tested for LA, aCL, and aβ2GPI, the frequency of moderate-to-high (≥40 U) titers of aCL and aβ2GPI IgG/IgM/IgA was higher in patients who were positive for LA vs those who were negative. An aPL Load was calculated for each patient to assess the overall aPL burden. For every 1-point increase in the aPL Load, the possibility of a positive LA test increased by 32% (odds ratio, 1.32; 95% CI, 1.2-1.5; P < .001). Based on core laboratory data from a large international registry, most aPL enzyme-linked immunosorbent assay ≥40 U and a high calculated aPL Load combining 6 aPL enzyme-linked immunosorbent assays were predictive of a positive LA. These data suggest that the combined quantitative burden of aPL may provide a mechanistic explanation of a positive LA.
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Affiliation(s)
- Elena Gkrouzman
- Division of Rheumatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
| | - Rohan Willis
- University of Texas Medical Branch, Galveston, Texas
| | | | | | | | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Biocruces Bizkaia Health Research Institute, UPV/EHU, Bizkaia, The Basque Country, Spain
| | | | - Paul R Fortin
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | | | | | | | - D Ware Branch
- James R. and Jo Scott Research Chair, University of Utah and Intermountain Healthcare, Salt Lake City, Utah
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Michelle A Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ricard Cervera
- Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan
| | - Maria Efthymiou
- Haemostasis Research Unit, Department of Hematology, University College London, London, United Kingdom
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Hematology, University College London, London, United Kingdom
| | | | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Robert Roubey
- University of North Carolina, Chapel Hill, North Carolina
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8
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Erton ZB, K Leaf R, de Andrade D, Clarke AE, Tektonidou MG, Pengo V, Sciascia S, Ugarte A, Belmont HM, Gerosa M, Fortin PR, Lopez-Pedrera C, Atsumi T, Zhang Z, Cohen H, Ramires de Jesús G, Branch DW, Wahl D, Andreoli L, Rodriguez-Almaraz E, Petri M, Barilaro G, Zuo Y, Artim-Esen B, Willis R, Quintana R, Vendramini MB, Barber MW, Bertolaccini ML, Roubey R, Erkan D. Immunosuppression use in primary antiphospholipid antibody-positive patients: Descriptive analysis of the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository ("Registry"). Lupus 2022; 31:1770-1776. [PMID: 36206383 DOI: 10.1177/09612033221128742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE APS ACTION Registry was created to study the outcomes of patients with persistently positive antiphospholipid antibodies (aPL) with or without other systemic autoimmune disease (SAIDx). Given that immunosuppression (IS) is used for certain aPL manifestations, for example, thrombocytopenia (TP), our primary objective was to describe the indications for IS in aPL-positive patients without other SAIDx. Secondly, we report the type of IS used in patients with selected microvascular or non-thrombotic aPL manifestations. METHODS An online database is used to collect clinical data. The inclusion criteria are positive aPL based on the laboratory section of the APS Classification Criteria, tested at least twice within one year prior to enrollment. Patients are followed every 12 ± 3 months. For this descriptive retrospective and prospective analysis, we included aPL-positive patients without other SAIDx and excluded those with new SAIDx classification during follow-up. For each patient, we retrieved clinical data at baseline and follow-up including selected aPL manifestations (diffuse alveolar hemorrhage [DAH], antiphospholipid-nephropathy [aPL-N], livedoid vasculopathy [LV]-related skin ulcers, TP, autoimmune hemolytic anemia [AIHA], cardiac valve disease [VD]), and IS medications. RESULTS Of 899 patients enrolled, 537 were included in this analysis (mean age 45 ± 13 years, female 377 [70%], APS Classification in 438 [82%], and at least one selected microvascular or non-thrombotic aPL manifestation in 141 (26%)). Of 537 patients, 76 (14%) were reported to use IS (ever), and 41/76 (54%) received IS primarily for selected aPL manifestation. In six of 8 (75%) DAH patients, 6/19 (32%) aPL-N, 4/28 (14%) LV, 25/88 (28%) TP, 6/11 (55%) AIHA, and 1/43 (2%) VD, the IS (excluding corticosteroids/hydroxychloroquine) indication was specific for selected aPL manifestation. CONCLUSION In our international cohort, 14% of aPL-positive patients without other SAIDx were reported to receive IS; the indication was at least one of the selected microvascular and/or non-thrombotic aPL-related manifestations in half. Thrombocytopenia was the most frequent among those selected aPL-related manifestations; however, approximately one-third received IS specifically for that indication. Diffuse alveolar hemorrhage was frequently treated with IS followed by AIHA and aPL-N. Systematic controlled studies are urgently needed to better define the role of IS in APS.
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Affiliation(s)
- Zeynep B Erton
- Rheumatology, 25062Hospital for Special Surgery, New York, NY, USA
| | - Rebecca K Leaf
- Hematology, 2348Massachusetts General Hospital, Boston, MA, USA
| | | | - Ann E Clarke
- Clinical Epidemiology, University of Calgary, Calgary, AB, Canada
| | - Maria G Tektonidou
- Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Vittorio Pengo
- Cardiothoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Savino Sciascia
- Centro Multidisciplinare di Ricerche di Immunopatologia e Documentazione su Malattie Rare, Struttura Complessa a Direzione Universitaria di Immunologia Clinica, University of Turin, Turin, Italy
| | - Amaia Ugarte
- Rheumatology, BioCruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - H Michael Belmont
- Rheumatology, New York University Langone Medical Center, New York, NY, USA
| | - Maria Gerosa
- Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paul R Fortin
- Rheumatology, CHU de Québec- Université Laval, Quebec, QC, Canada
| | - Chary Lopez-Pedrera
- Rheumatology, Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain
| | - Tatsuya Atsumi
- Medicine II, Hokkaido University Hospital, Sapporo, Japan
| | - Zhouli Zhang
- Rheumatology, Peking University First Hospital, Beijing, China
| | - Hannah Cohen
- Haematology, 4919University College London, London, UK
| | | | - David W Branch
- Obstetrics and Gynecology, 14434University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | - Denis Wahl
- Rheumatology, Université de Lorraine, Inserm DCAC, and CHRU-Nancy, Nancy, France
| | | | | | - Michelle Petri
- Rheumatology, 1466Johns Hopkins University, Baltimore, MD, USA
| | | | - Yu Zuo
- Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Bahar Artim-Esen
- Internal Medicine, Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Rohan Willis
- Internal Medicine, 12334University of Texas Medical Branch, Galveston, TX, USA
| | - Rosana Quintana
- Internal Medicine, Centro Regional de Enfermedades Autoinmunes y Reumáticas GO-CREAR, Rosario Santa Fe Argentina
| | | | - Megan W Barber
- Clinical Epidemiology, University of Calgary, Calgary, AB, Canada
| | | | - Robert Roubey
- Rheumatology, Allergy & Immunolog, University of North Carolina, Chapel Hill, NC, USA
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Disease, 25062Hospital for Special Surgery Weill Cornell Medicine, New York, NY, USA
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9
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Sevim E, Zisa D, Andrade D, Sciascia S, Pengo V, Tektonidou MG, Ugarte A, Gerosa M, Michael Belmont H, Zamorano MAA, Fortin PR, Ji L, Efthymiou M, Cohen H, Ware Branch D, de Jesus GR, Andreoli L, Petri M, Rodriguez E, Cervera R, Knight JS, Atsumi T, Willis R, Roubey R, Bertolaccini ML, Erkan D, Barbhaiya M. Characteristics of Patients With Antiphospholipid Antibody Positivity in the APS ACTION International Clinical Database and Repository. Arthritis Care Res (Hoboken) 2022; 74:324-335. [PMID: 32986935 PMCID: PMC10725727 DOI: 10.1002/acr.24468] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 09/04/2020] [Accepted: 09/22/2020] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To describe the baseline characteristics of patients with positivity for antiphospholipid antibodies (aPLs) who were enrolled in an international registry, the Antiphospholipid Syndrome (APS) Alliance for Clinical Trials and International Networking (APS ACTION) clinical database and repository, overall and by clinical and laboratory subtypes. METHODS The APS ACTION registry includes adults who persistently had positivity for aPLs. We evaluated baseline sociodemographic and aPL-related (APS classification criteria and "non-criteria") characteristics of patients overall and in subgroups (aPL-positive without APS, APS overall, thrombotic APS only, obstetric APS only, and both thrombotic APS/obstetric APS). We assessed baseline characteristics of patients tested for the presence of three aPLs (lupus anticoagulant [LAC] test, anticardiolipin antibody [aCL], and anti-β2 -glycoprotein I [anti-β2 GPI]) antibodies by aPL profiles (LAC only, single, double, and triple aPL positivity). RESULTS The 804 aPL-positive patients assessed in the present study had a mean age of 45 ± 13 years, were 74% female, and 68% White; additionally, 36% had other systemic autoimmune diseases. Of these 804 aPL-positive patients, 80% were classified as having APS (with 55% having thrombotic APS, 9% obstetric APS, and 15% thrombotic APS/obstetric APS). In the overall cohort, 71% had vascular thrombosis, 50% with a history of pregnancy had obstetric morbidity, and 56% had experienced at least one non-criteria manifestation. Among those with three aPLs tested (n = 660), 42% were triple aPL-positive. While single-, double-, and triple aPL-positive subgroups had similar frequencies of vascular, obstetric, and non-criteria events, these events were lowest in the single aPL subgroup, which consisted of aCLs or anti-β2 GPI only. CONCLUSION Our study demonstrates the heterogeneity of aPL-related clinical manifestations and laboratory profiles in a multicenter international cohort. Within single aPL positivity, LAC may be a major contributor to clinical events. Future prospective analyses, using standardized core laboratory aPL tests, will help clarify aPL risk profiles and improve risk stratification.
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Affiliation(s)
- Ecem Sevim
- Ecem Sevim, MD: Hospital for Special Surgery, New York, New York, and Montefiore Medical Center, Bronx, New York
| | - Diane Zisa
- Diane Zisa, MD, Doruk Erkan, MD, MPH, Medha Barbhaiya, MD, MPH: Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Danieli Andrade
- Danieli Andrade, MD, PhD: University of Sao Paulo, Sao Paulo, Brazil
| | | | - Vittorio Pengo
- Vittorio Pengo, MD: University Hospital Padova, Padova, Italy
| | - Maria G. Tektonidou
- Maria G. Tektonidou, MD: National and Kapodistrian University of Athens, Athens, Greece
| | - Amaia Ugarte
- Amaia Ugarte, MD: Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
| | - Maria Gerosa
- Maria Gerosa, MD, PhD: University of Milan, Milan, Italy
| | - H. Michael Belmont
- H. Michael Belmont, MD: New York University Langone Medical Center, New York, New York
| | | | - Paul R. Fortin
- PaulR. Fortin, MD, PhD: CHU de Québec and Université Laval, Quebec City, Canada
| | - Lanlan Ji
- Lanlan Ji, MD: Peking University First Hospital, Beijing, China
| | - Maria Efthymiou
- MariaEfthymiou, PhD, Hannah Cohen, MD: University College London, London, UK
| | - Hannah Cohen
- MariaEfthymiou, PhD, Hannah Cohen, MD: University College London, London, UK
| | - D. Ware Branch
- D. Ware Branch, MD: University of Utah and Intermountain Healthcare, Salt Lake City, Utah
| | | | - Laura Andreoli
- Laura Andreoli, MD, PhD: University of Brescia, Brescia, Italy
| | - Michelle Petri
- Michelle Petri, MD, MPH: Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Esther Rodriguez
- Esther Rodriguez, MD: Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ricard Cervera
- Ricard Cervera, MD, PhD, FRCP: Hospital Clínic Institut d’Investigacions Biomèdiques August Pi i Sunyer(IDIBAPS), Barcelona, Catalonia, Spain
| | | | - Tatsuya Atsumi
- Tatsuya Atsumi, MD, PhD: Hokkaido University Hospital, Sapporo, Japan
| | - Rohan Willis
- Rohan Willis, MD: University of Texas Medical Branch, Galveston
| | - Robert Roubey
- Robert Roubey, MD: University of North Carolina, Chapel Hill
| | | | - Doruk Erkan
- Diane Zisa, MD, Doruk Erkan, MD, MPH, Medha Barbhaiya, MD, MPH: Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Medha Barbhaiya
- Diane Zisa, MD, Doruk Erkan, MD, MPH, Medha Barbhaiya, MD, MPH: Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
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10
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Desai RJ, Hansen RA, Rao JK, Wilkins TM, Harden EA, Yuen A, Jonas DE, Roubey R, Jonas B, Gartlehner G, Lux L, Donahue KE. Mixed treatment comparison of the treatment discontinuations of biologic disease-modifying antirheumatic drugs in adults with rheumatoid arthritis. Ann Pharmacother 2012; 46:1491-505. [PMID: 23092868 DOI: 10.1345/aph.1r203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Introduction of biologic disease-modifying antirheumatic drugs (DMARDs) has considerably changed treatment options for rheumatoid arthritis (RA) over the past decade. Very little information is available on comparative discontinuation rates of the biologics. OBJECTIVE To compare treatment discontinuations for 9 biologic DMARDs in adults with RA. METHODS We searched electronic databases through May 2012 to retrieve randomized controlled trials (RCTs) of patients with RA that compared biologic DMARDs with placebo or another biologic DMARD. The primary outcome was treatment discontinuation during the blinded phase of the trials, measured as overall withdrawals, withdrawals resulting from lack of efficacy, and withdrawals resulting from adverse events. Random-effects meta-analysis estimated the effect size for individual agents, and adjusted indirect comparisons were made between biologics using mixed treatment comparisons (MTC) meta-analysis. RESULTS Forty-four trials were included in the analysis. In comparison with placebo, biologics were less likely to be withdrawn because of lack of efficacy (OR 0.22, 95% CI 0.17 to 0.27) and more likely to be withdrawn because of an adverse event (OR 1.41, 95% CI 1.16 to 1.70). Based on the MTC, certolizumab had the most favorable overall withdrawal profile, followed by etanercept and rituximab. Certolizumab had lower relative withdrawal rates resulting from lack of efficacy than adalimumab, anakinra, and infliximab. Anakinra had higher relative withdrawal rates resulting from lack of efficacy than most other biologics. Certolizumab and infliximab had more, while etanercept had fewer, withdrawals because of adverse events than most other drugs. CONCLUSIONS Based on MTC using data from RCTs, differences in discontinuation rates were observed, generally favoring certolizumab, etanercept, and rituximab over other biologic DMARDs. These potential differences need to be further explored in head-to-head trials or well-conducted observational studies.
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Affiliation(s)
- Rishi J Desai
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
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Erkan D, Derksen R, Levy R, Machin S, Ortel T, Pierangeli S, Roubey R, Lockshin M. Antiphospholipid Syndrome Clinical Research Task Force report. Lupus 2011; 20:219-24. [PMID: 21303838 DOI: 10.1177/0961203310395053] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Antiphospholipid Syndrome (APS) Clinical Research Task Force (CRTF) was one of six Task Forces developed by the 13(th) International Congress on Antiphospholipid Antibodies (aPL) organization committee with the purpose of: a) evaluating the limitations of APS clinical research and developing guidelines for researchers to help improve the quality of APS research; and b) prioritizing the ideas for a well-designed multicenter clinical trial and discussing the pragmatics of getting such a trial done. Following a systematic working algorithm, the Task Force identified five major issues that impede APS clinical research and the ability to develop evidence-based recommendations for the management of aPL-positive patients: (1) aPL detection has been based on partially or non-standardized tests, and clinical (and basic) APS research studies have included patients with heterogeneous aPL profiles with different clinical event risks; (2) clinical (and basic) APS research studies have included a heterogeneous group of patients with different aPL-related manifestations (some controversial); (3) thrombosis and/or pregnancy risk stratification and quantification are rarely incorporated in APS clinical research; (4) most APS clinical studies include patients with single positive aPL results and/or low-titer aPL ELISA results; furthermore, study designs are mostly retrospective and not population based, with limited number of prospective and/or controlled population studies; and (5) lack of the understanding the particular mechanisms of aPL-mediated clinical events limits the optimal clinical study design. The Task Force recommended that there is an urgent need for a truly international collaborative approach to design and conduct well-designed prospective large-scale multi-center clinical trials of patients with persistent and clinically significant aPL profiles. An international collaborative meeting to formulate a good research question using 'FINER' (Feasible; Interesting; Novel; Ethical; and Relevant) criteria took place in November 2010.
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Affiliation(s)
- D Erkan
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
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12
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Pierangeli SS, Groot PGD, Dlott J, Favaloro E, Harris EN, Lakos G, Ortel T, Meroni PL, Otomo K, Pengo V, Tincani A, Wong R, Roubey R. ‘Criteria’ aPL tests: Report of a Task Force and preconference workshop at the 13th International Congress on Antiphospholipid Antibodies, Galveston, Texas, April 2010. Lupus 2011; 20:182-90. [DOI: 10.1177/0961203310395055] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current classification criteria for definite antiphospholipid syndrome (APS) mandate the use of one or more of three positive ‘standardized’ laboratory assays to detect antiphospholipid antibodies (aPL) (viz: anticardiolipin [aCL] IgG and IgM; anti-β2glycoprotein I [anti-β2GPI] antibodies IgG and IgM; and/or a lupus anticoagulant [LAC]), when at least one of the two major clinical manifestations (thrombosis or pregnancy losses) are present. Although, efforts of standardization for these ‘criteria’ aPL tests have been conducted over the last 27 years, reports of inconsistencies, inter-assay and inter-laboratory variation in the results of aCL, LAC, and anti-β2GPI, and problems with the interpretation and the clinical value of the tests still exist, which affect the consistency of the diagnosis of APS. A Task Force of scientists and pioneers in the field from different countries, subdivided in three working groups, discussed and analyzed critical questions related to ‘criteria’ aPL tests in an evidence-based manner, during the 13th International Congress on Antiphospholipid Antibodies (APLA 2010, April 13–16, 2010, Galveston, TX). These included: review of the standardization and the need for international consensus protocol for aCL and anti-β2GPI tests; the use of monoclonal and/or polyclonal standards in the calibration curve of those tests; and the need for establishment of international units of measurement for anti-β2GPI tests. The group also reviewed the recently updated guidelines for LAC testing, and analyzed and discussed the possibility of stratification of ‘criteria’ aPL tests as risk factors for APS, as well as the clinical value of single positive vs. multiple aPL positivity. The group members presented, discussed, analyzed data, updated and re-defined those critical questions at a preconference workshop that was open to congress attendees. This report summarizes the findings, conclusions, and recommendations of this Task Force.
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Affiliation(s)
- SS Pierangeli
- Antiphospholipid Standardization Laboratory, Division of Rheumatology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - PG de Groot
- Department of Clinical Chemistry and Haematology, University Medical Center, Utrecht, The Netherlands
| | - J Dlott
- Quest Diagnostics Laboratories, Chantilly, VA, USA
| | - E Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, Westmead, NSW, Australia
| | - EN Harris
- University of the West Indies, Kingston, Jamaica
| | - G Lakos
- TheraTest Inc. Laboratories, Lombard, IL, USA
| | - T Ortel
- Clinical Coagulation Laboratory, Laboratory-Based Research, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - PL Meroni
- Division of Rheumatology, Dept of Internal Medicine, Ist G. Pini and Istituto Auxologico Italiano, Milan, Italy
| | - K Otomo
- Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - V Pengo
- Clinical Cardiology, Thrombosis Centre, Department of Cardiac Throracic and Vascular Sciences, University of Padova, Padova, Italy
| | - A Tincani
- Rheumatology and Clinical Immunology Unit, Spedali Civili and University of Brescia, Italy
| | - R Wong
- Division of Immunology, Pathology, Queensland, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - R Roubey
- Division of Rheumatology, Allergy, and Immunology and Thurston Arthritis Research Center, The University of North Carolina, Chapel Hill, North Carolina, USA
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Wiser J, Alexis NE, Jiang Q, Wu W, Robinette C, Roubey R, Peden DB. In vivo gamma-tocopherol supplementation decreases systemic oxidative stress and cytokine responses of human monocytes in normal and asthmatic subjects. Free Radic Biol Med 2008; 45:40-9. [PMID: 18405673 PMCID: PMC2492672 DOI: 10.1016/j.freeradbiomed.2008.03.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Revised: 03/03/2008] [Accepted: 03/03/2008] [Indexed: 12/30/2022]
Abstract
We have recently reported that gamma-tocopherol (gammaT) reduces allergen- and zymosan-induced inflammation using rodent models. As an initial step in extending these observations to humans, we conducted an open-label, Phase I dosing study of two doses (one or two capsules daily for 1 week) of a gamma-tocopherol-rich preparation containing 623 mg of gamma-tocopherol, 61.1 mg of d-alpha-tocopherol, 11.1 mg of d-beta-tocopherol (11.1 mg), and 231 mg of d-sigma-tocopherol per capsule. Endpoints for this study include serum levels of 5-nitro-gamma-tocopherol, as a marker of oxidative stress, and changes in serum gamma-, alpha-, and delta-tocopherol and gamma-2'-carboxyethyl-6-hydroxychroman (CEHC) 6 and 24 h after the first dose and after 1 week of treatment. To assess the biological activity of this treatment, we obtained peripheral blood mononuclear cells at baseline and after 1 week of treatment with two capsules of a gamma-tocopherol-rich preparation/day and examined the inflammatory cytokine response of these cells in culture to ex vivo endotoxin/LPS (0.01 ng/ml) challenge. We also monitored a number of safety endpoints to examine how well this preparation is tolerated in eight normal volunteers (four allergic and four nonallergic) and eight allergic asthmatics. We further obtained human monocytes from a subset of these volunteers and treated them ex vivo with gammaT, alphaT, gamma-CEHC, and alpha-CEHC and assessed their actions on LPS-induced degradation of IkappaBalpha and JNK signaling and ROS generation. As detailed herein, this open-label study demonstrates that gamma-tocopherol-enriched supplementation decreased systemic oxidative stress, increased serum levels of gamma-tocopherol, and inhibited monocyte responses to LPS without any adverse health effects. Further, in vitro treatment of human monocytes with gamma-CEHC and alpha-CEHC inhibits ROS generation and LPS-induced degradation of IkappaB and JNK activation.
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Affiliation(s)
| | - Neil E. Alexis
- The Center for Environmental Medicine, Asthma and Lung Biology, the University of North Carolina School of Medicine, Chapel Hill, NC
| | - Qing Jiang
- Department of Foods and Nutrition, College of Consumer and Family Science, Purdue University, West Lafayette, IN
| | - Weidong Wu
- The Center for Environmental Medicine, Asthma and Lung Biology, the University of North Carolina School of Medicine, Chapel Hill, NC
| | - Carole Robinette
- The Center for Environmental Medicine, Asthma and Lung Biology, the University of North Carolina School of Medicine, Chapel Hill, NC
| | - Robert Roubey
- The Center for Environmental Medicine, Asthma and Lung Biology, the University of North Carolina School of Medicine, Chapel Hill, NC
| | - David B. Peden
- The Center for Environmental Medicine, Asthma and Lung Biology, the University of North Carolina School of Medicine, Chapel Hill, NC
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14
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Savelli S, Roubey R, Wu YL, Buxton G, Nagaraja H, Yang Y, Yu CY. Complement components C4 and C3 in human subjects with antiphospholipid antibodies: High C4B in antiphospholipid syndrome (APS) and low C4A in systemic lupus erythematosus (SLE). Mol Immunol 2007. [DOI: 10.1016/j.molimm.2006.07.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Erkan D, Derksen WJM, Kaplan V, Sammaritano L, Pierangeli SS, Roubey R, Lockshin MD. Real world experience with antiphospholipid antibody tests: how stable are results over time? Ann Rheum Dis 2005; 64:1321-5. [PMID: 15731290 PMCID: PMC1755632 DOI: 10.1136/ard.2004.031856] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the stability and the degree of variation of antiphospholipid antibody (aPL) results over time in a large cohort of well evaluated aPL positive patients; and to analyse factors contributing to aPL variation and the validity of aPL in a real world setting in which aPL tests are done in multiple laboratories. METHODS The clinical characteristics, drug treatment, and 1652 data points for lupus anticoagulant (LA), anticardiolipin antibodies (aCL), and anti-beta2 glycoprotein I antibodies (anti-beta2GPI) were examined in 204 aPL positive patients; 81 of these met the Sapporo criteria for antiphospholipid syndrome (APS) and 123 were asymptomatic bearers of aPL. RESULTS 87% of initially positive LA results, 88% of initially negative to low positive aCL results, 75% of initially moderate to high positive aCL results, 96% of initially negative to low positive anti-beta2GPI results, and 76% of initially moderate to high positive anti-beta2GPI results subsequently remained in the same range regardless of the laboratory performing the test. Aspirin, warfarin, and hydroxychloroquine use did not differ among patients whose aCL titres significantly decreased or increased or remained stable. On same day specimens, the consistency of aCL results among suppliers ranged from 64% to 88% and the correlation ranged from 0.5 to 0.8. Agreement was moderate for aCL IgG and aCL IgM; however, for aCL IgA agreement was marginal. CONCLUSIONS aPL results remained stable for at least three quarters of subsequent tests, regardless of the laboratory performing the test; the small amount of variation that occurred did not appear to be caused by aspirin, warfarin, or hydroxychloroquine use.
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Affiliation(s)
- D Erkan
- Department of Rheumatology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E70th Street, New York, NY 10021, USA.
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16
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Alarcón-Segovia D, Boffa MC, Branch W, Cervera R, Gharavi A, Khamashta M, Shoenfeld Y, Wilson W, Roubey R. Prophylaxis of the antiphospholipid syndrome: a consensus report. Lupus 2003; 12:499-503. [PMID: 12892387 DOI: 10.1191/0961203303lu388oa] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hypothetical circumstances that may require prophylaxis for a potential antiphospholipid syndrome (primary prophylaxis), or in some instances when there already had been some manifestations ofthe syndrome (secondary prophylaxis), were presented to a panel of experts for their consideration on potential prophylactic intervention. These were subsequently presented to the participants in the First International Consensus on Treatment of the Antiphospholipid Syndrome. In most instances there was consensus in adding low dose aspirin, an exception being aspirin allergy when other antiaggregants could be used in nonpregnant subjects. General measures to prevent thrombosis and other vasoprotective actions should also be provided. Higher risk of fetal loss or thrombosis called for anticoagulation with coumadin in nonpregnant subjects or subcutaneous low molecular weight heparin in pregnant ones. When indicated, prophylaxis of the antiphospholipid syndrome should be provided in systemic lupus erythematosus patients who are being treated for their disease. In no instance should corticosteroids or immunosuppresants be given as prophylactic of an antiphospholipid syndrome.
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Affiliation(s)
- D Alarcón-Segovia
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico DF, Mexico.
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17
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Wang MX, Kandiah DA, Ichikawa K, Khamashta M, Hughes G, Koike T, Roubey R, Krilis SA. Epitope specificity of monoclonal anti-beta 2-glycoprotein I antibodies derived from patients with the antiphospholipid syndrome. J Immunol 1995; 155:1629-36. [PMID: 7543528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
beta 2-Glycoprotein I (beta 2GPI) has been identified as a cofactor in the recognition of the phospholipid Ag cardiolipin (CL) by anticardiolipin Ab (aCL) purified from patients with autoimmune diseases. However, there is considerable controversy as to the exact nature of the epitopes to which these Abs are directed. mAb derived from patients with the antiphospholipid syndrome bound to CL only in the presence of beta 2GPI. Synthetic peptides that span the fifth C-terminal domain of beta 2GPI supported the binding of one of the mAbs to CL in a beta 2GPI-free system. These peptides possessed the phospholipid binding sequence Cys281-Lys-Asn-Lys-Glu-Lys-Lys-Cys288. Three of the mAbs bound to beta 2GPI that had been adsorbed on gamma-irradiated microtiter plates. Binding to beta 2GPI was inhibited in a dose-dependent manner by the peptides from the carboxyl-terminal end of beta 2GPI and soluble beta 2GPI, indicating that the mAb bound to peptides and beta 2GPI in free solution. Thus, mAbs derived from patients with the antiphospholipid syndrome have specificity for epitopes on the fifth domain of beta 2GPI. Our results support the idea that beta 2GPI acts as a primary Ag for these Abs.
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Affiliation(s)
- M X Wang
- Department of Immunology, Allergy, and Infectious Disease, University of New South Wales School of Medicine, St. George Hospital, Kogarah, Australia
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18
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Wang MX, Kandiah DA, Ichikawa K, Khamashta M, Hughes G, Koike T, Roubey R, Krilis SA. Epitope specificity of monoclonal anti-beta 2-glycoprotein I antibodies derived from patients with the antiphospholipid syndrome. The Journal of Immunology 1995. [DOI: 10.4049/jimmunol.155.3.1629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
beta 2-Glycoprotein I (beta 2GPI) has been identified as a cofactor in the recognition of the phospholipid Ag cardiolipin (CL) by anticardiolipin Ab (aCL) purified from patients with autoimmune diseases. However, there is considerable controversy as to the exact nature of the epitopes to which these Abs are directed. mAb derived from patients with the antiphospholipid syndrome bound to CL only in the presence of beta 2GPI. Synthetic peptides that span the fifth C-terminal domain of beta 2GPI supported the binding of one of the mAbs to CL in a beta 2GPI-free system. These peptides possessed the phospholipid binding sequence Cys281-Lys-Asn-Lys-Glu-Lys-Lys-Cys288. Three of the mAbs bound to beta 2GPI that had been adsorbed on gamma-irradiated microtiter plates. Binding to beta 2GPI was inhibited in a dose-dependent manner by the peptides from the carboxyl-terminal end of beta 2GPI and soluble beta 2GPI, indicating that the mAb bound to peptides and beta 2GPI in free solution. Thus, mAbs derived from patients with the antiphospholipid syndrome have specificity for epitopes on the fifth domain of beta 2GPI. Our results support the idea that beta 2GPI acts as a primary Ag for these Abs.
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Affiliation(s)
- M X Wang
- Department of Immunology, Allergy, and Infectious Disease, University of New South Wales School of Medicine, St. George Hospital, Kogarah, Australia
| | - D A Kandiah
- Department of Immunology, Allergy, and Infectious Disease, University of New South Wales School of Medicine, St. George Hospital, Kogarah, Australia
| | - K Ichikawa
- Department of Immunology, Allergy, and Infectious Disease, University of New South Wales School of Medicine, St. George Hospital, Kogarah, Australia
| | - M Khamashta
- Department of Immunology, Allergy, and Infectious Disease, University of New South Wales School of Medicine, St. George Hospital, Kogarah, Australia
| | - G Hughes
- Department of Immunology, Allergy, and Infectious Disease, University of New South Wales School of Medicine, St. George Hospital, Kogarah, Australia
| | - T Koike
- Department of Immunology, Allergy, and Infectious Disease, University of New South Wales School of Medicine, St. George Hospital, Kogarah, Australia
| | - R Roubey
- Department of Immunology, Allergy, and Infectious Disease, University of New South Wales School of Medicine, St. George Hospital, Kogarah, Australia
| | - S A Krilis
- Department of Immunology, Allergy, and Infectious Disease, University of New South Wales School of Medicine, St. George Hospital, Kogarah, Australia
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19
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Ritchlin CT, Chabot RJ, Alper K, Buyon J, Belmont HM, Roubey R, Abramson SB. Quantitative electroencephalography. A new approach to the diagnosis of cerebral dysfunction in systemic lupus erythematosus. Arthritis Rheum 1992; 35:1330-42. [PMID: 1445450 DOI: 10.1002/art.1780351114] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Neuropsychiatric manifestations are common in patients with systemic lupus erythematosus (SLE), but accurate diagnosis is often difficult. We conducted a prospective study to determine the utility of neurometric quantitative electroencephalography (QEEG) as an indicator of cerebral dysfunction in SLE patients. METHODS Fifty-two SLE patients were divided into 4 groups based on the results of neuropsychiatric evaluations. These included patients with objective evidence of neuropsychiatric SLE (NPSLE), patients with neuropsychiatric symptoms, patients with no evidence of NPSLE, and patients with a prior history of NPSLE: All QEEG findings were compared with data in an age-regressed normative database and with findings in an independent sample of normal subjects. RESULTS QEEG sensitivity was 87%, and specificity was 75%. QEEG results were abnormal in 74% of the SLE patients with neuropsychiatric symptoms and in 28% of the patients with no evidence of active NPSLE: QEEG profiles varied as a function of the severity and type of neuropsychiatric manifestation present. Within this patient population, QEEG was more sensitive than magnetic resonance imaging, computed tomography scanning, or conventional EEG. CONCLUSION Neurometric QEEG may be a sensitive indicator of cerebral dysfunction in patients with NPSLE and can differentiate patients with diverse neuropsychiatric manifestations. When combined with a careful clinical history and evaluation, QEEG provides information that may be useful for the early detection of NPSLE and for serial evaluation of disease activity and treatment efficacy.
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Affiliation(s)
- C T Ritchlin
- Department of Psychiatry, New York University School of Medicine, New York
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20
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Chou CH, Ali SA, Roubey R, Buyon J, Reeves WH. Onset and regulation of anti-lamin B autoantibody production is independent of the level of polyclonal activation. Autoimmunity 1991; 8:297-305. [PMID: 1932514 DOI: 10.3109/08916939109007637] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Anti-lamin B autoantibodies are associated with both systemic lupus erythematosus (SLE) and autoimmune liver disease. We examined the possibility that the underlying clinical feature in patients with anti-lamin B autoantibodies might be chronic autoimmune liver disease, and whether the hypergammaglobulinemia present in both disorders is involved in generating anti-lamin B autoantibodies. A lamin B fusion protein (MLB1), consisting of amino acids 77-533 of lamin B fused to TrpE, was used to screen sera from 84 patients with SLE for anti-lamin B autoantibodies. 3/4 prototype human lamin B antisera, 5/84 SLE sera (6%), and 0/30 sera from healthy individuals reacted with MLB1 on immunoblots at a 1:500 dilution. Of the 9 anti-lamin B autoantibody positive patients studied, all but 1 fulfilled at least four ARA criteria for SLE. None of the patients displayed evidence of chronic autoimmune liver disease, suggesting that autoimmune liver disease is not strongly associated with anti-lamin B antibodies in SLE. In SLE, as in "lupoid hepatitis", anti-lamin B autoantibodies are often produced transiently during periods of increased disease activity. Although polyclonal hypergammaglobulinemia is also associated with increased activity of both diseases, anti-lamin B autoantibody production in 2 patients was independent of total immunoglobulin levels, antibodies to irrelevant proteins, and production of some other autoantibodies. Thus, polyclonal activation is insufficient to explain either the initiation or regulation of anti-lamin B autoantibody production, supporting the hypothesis that antinuclear antibodies are antigen-selective.
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Affiliation(s)
- C H Chou
- Laboratory of Cell Biology, Rockefeller University, New York, NY 10021
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21
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Buyon J, Roubey R, Swersky S, Pompeo L, Parke A, Baxi L, Winchester R. Complete congenital heart block: risk of occurrence and therapeutic approach to prevention. J Rheumatol 1988; 15:1104-8. [PMID: 3262756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A retrospective literature review revealed that in 41% of cases of complete congenital heart block (CCHB) there was at least one other affected sibling, emphasizing the considerable risk of carrying a second affected fetus with CCHB. Therefore an aggressive approach was taken to prevent CCHB in a fetus with a high risk for the condition as defined by (1) presence of DR3 and high titers of antibodies to SSA(Ro) and SSB(La) in the mother (2) previous history of CCHB in a sibling. In a feasibility study, thrice weekly plasmapheresis was initiated in the 19th week of gestation to remove antibodies from the maternal circulation in advance of major placental transport to the developing fetus. Prednisone was also administered to decrease antibody synthesis. The concentration of total maternal IgG and antibodies to SSA(Ro) and SSB(La) were decreased by greater than 60% during the course of therapy. Planned delivery of a healthy baby was done at 36 weeks.
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Affiliation(s)
- J Buyon
- Department of Medicine, Hospital for Joint Diseases, NYU School of Medicine, NY 10003
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