Emerging treatments
Hydroxychloroquine
Hydroxychloroquine has been associated with a decreased risk of thrombotic events in patients with systemic lupus erythematosus.[19][60][77] Additionally, retrospective studies have shown that pregnancy outcome is improved in those receiving hydroxychloroquine. Randomized controlled trials assessing the use of hydroxychloroquine on pregnancy outcome are ongoing in Europe.[78] Hydroxychloroquine has been shown to reverse the binding of antiphospholipid antibody-beta2-glycoprotein I complexes to phospholipid bilayers - a potentially important pathogenic mechanism in the development of thrombosis in antiphospholipid syndrome (APS).[79] One small randomized controlled trial suggests that hydroxychloroquine might also be a useful adjunctive treatment in reducing thrombotic events in patients with primary APS.[80]
Statins
It is not known whether statins should be prescribed to patients with APS. Statins should be considered in all patients after an assessment of cholesterol values and other cardiovascular risk factors, especially in patients meeting criteria for APS based on prior arterial thromboembolic events. There is very little data evaluating statins in patients with APS specifically.[81] Statins may reduce the risk of venous thromboembolism, but further study is needed in patients with APS.[19][82][83]
Biologics
Biologic agents are being studied in APS, because the pathogenesis of APS supports their use as a targeted treatment approach.[84] Belimumab, a monoclonal antibody that inhibits the B lymphocyte stimulator protein (BLyS), is being studied in the BLAST trial.[85] The use of antitumor necrosis factor (TNF)-alpha monoclonal antibodies, specifically certolizumab pegol, is being studied in the IMPACT trial for obstetric APS.[86]
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