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Top 10 Clinical Research Developments in Antiphospholipid Syndrome

  • SYSTEMIC LUPUS ERYTHEMATOSUS (M PETRI, SECTION EDITOR)
  • Published:
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Abstract

Persistently positive antiphospholipid antibodies (aPL) with thrombosis and/or pregnancy morbidity are a characteristic of antiphospholipid syndrome (APS). Although many challenges and controversies exist regarding APS diagnosis and management, there has been significant progress in APS clinical research in parallel with increased understanding of the pathogenesis. The purpose of this review is to discuss the “top ten” recent clinical developments in APS, including the magnitude of the problem, standardization of aPL tests, predictors of clinical events, diagnostic algorithms, new clinical research collaboration, and potential future treatments, e.g., new anticoagulants and immunosuppressive agents.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295–306.

    Article  PubMed  CAS  Google Scholar 

  2. •• Andreoli L, Chighizola CB, Banzato A, et al. The estimated frequency of antiphospholipid antibodies in patients with pregnancy morbidity, stroke, myocardial infarction, and deep vein thrombosis. Arthritis Care Res (Hoboken). 2013. doi:10.1002/acr.22066. This is the first study performed to assess the prevalence of aPL in the general population among patients with pregnancy loss, stroke, myocardial infarction, and deep venous thrombosis.

  3. Peaceman AM, Silver RK, MacGregor SN, Socol ML. Interlaboratory variation in antiphospholipid antibody testing. Am J Obstet Gynecol. 1992;166:1780–4.

    Article  PubMed  CAS  Google Scholar 

  4. Carreras LO, Forastiero RR, Martinuzzo ME. Which are the best biological markers of the antiphospholipid syndrome? J Autoimmun. 2000;15:163–72.

    Article  PubMed  CAS  Google Scholar 

  5. Kutteh WH, Franklin RD. Assessing the variation in antiphospholipid antibody (APA) assays: comparison of results from 10 centers. Am J Obstet Gynecol. 2004;191:440–8.

    Article  PubMed  CAS  Google Scholar 

  6. •• Pierangeli SS, de Groot PG, Dlott J, et al. ‘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. This paper summarizes recent efforts to address laboratory standardization of aPL tests and recommendations proposed by the APS Task Force during the 13th International Congress on Antiphospholipid Antibodies in Galveston, Texas in 2010.

    Article  PubMed  CAS  Google Scholar 

  7. •• Lakos G, Favaloro EJ, Harris EN, et al. International consensus guidelines on anticardiolipin and anti-β2-glycoprotein I testing: report from the 13th International Congress on Antiphospholipid Antibodies. Arthritis Rheum. 2012;64:1–10. The purpose of this paper is to provide kit developers and clinical and research laboratories with recommendations regarding aCL and anti-β2GPI testing and interpretation of aPL antibody test results.

    Article  PubMed  Google Scholar 

  8. Shah NM, Khamashta MA, Atsumi T, et al. Outcome of patients with anticardiolipin antibodies: a 10 year follow-up of 52 patients. Lupus. 1998;7:3–6.

    Article  PubMed  CAS  Google Scholar 

  9. Ruffatti A, Del Ross T, Ciprian M, et al. Risk factors for a first thrombotic event in antiphopholipid antibody carriers. A multicentre, retrospective follow-up study. Ann Rheum Dis. 2009;68:397–9.

    Article  PubMed  CAS  Google Scholar 

  10. Hereng T, Lambert M, Hachulla E, et al. Influence of aspirin on the clinical outcomes of 103 antiphospholipid antibodies-positive patients. Lupus. 2008;17:11–5.

    Article  PubMed  CAS  Google Scholar 

  11. Finazzi G, Brancaccio V, Moia A, et al. Natural history and risk factors for thrombosis in 360 patients with antiphospholipid antibodies: a four year prospective study from the Italian registry. Am J Med. 1996;100:530–6.

    Article  PubMed  CAS  Google Scholar 

  12. Somers E, Magder LS, Petri M. Antiphospholipid antibodies and incidence of venous thrombosis in a cohort of patients with systemic lupus erythematosus. J Rheumatol. 2002;29:2531–6.

    PubMed  CAS  Google Scholar 

  13. Tarr T, Lakos G, Bhattoa HP, et al. Analysis of risk factors for the development of thrombotic complications in antiphospholipid antibody positive lupus patients. Lupus. 2007;16:39–45.

    Article  PubMed  CAS  Google Scholar 

  14. Tektonidou MG, Laskari K, Panagiotakos DB, et al. Risk factors for thrombosis and primary thrombosis prevention in patients with systemic lupus erythematosus with or without antiphospholipid antibodies. Arthritis Rheum. 2009;61:29–36.

    Article  PubMed  Google Scholar 

  15. Giron-Gonzalez JA, Garcia del Rio E, Rodriguez-Martorell J, et al. Antiphospholipid syndrome and asymptomatic antiphospholipid antibody carriers: evolutive analysis of 404 individuals. J Rheumatol. 2004;31:1560–7.

    PubMed  Google Scholar 

  16. Otomo K, Atsumi T, Amengual O, et al. Efficacy of the antiphospholipid score for the diagnosis of antiphospholipid syndrome and its predictive value for thrombotic events. Arthritis Rheum. 2012;64:504–12.

    Article  PubMed  CAS  Google Scholar 

  17. Sciascia S, Sanna G, Murru V, et al. GAPSS: the global anti-phospholipid syndrome score. Rheumatology (Oxford). 2013;52:1397–403.

    Google Scholar 

  18. •• Pengo V, Ruffatti A, Legnani C, et al. Incidence of a first thromboembolic event in asymptomatic carriers of high-risk antiphospholipid antibody profile: a multicenter prospective study. Blood. 2011;118:4714–8. This study demonstrated that the occurrence of a first thromboembolic event in carriers of a high-risk aPL profile is more frequent among male subjects and in the presence of additional risk factors for venous thromboembolic events, and that aspirin use did not significantly affect the incidence of thromboembolic events.

    Article  PubMed  CAS  Google Scholar 

  19. Erkan D, Lockshin MD. High risk antiphospholipid antibody profile: matter of the number or titer of tests? E-letter to the editor (re: Incidence of first thrombembolic event in asymptomatic carries of high-risk aPL profile: a multicenter prospective study. Pengo et al., Blood 2011;17:4714), Published online on 1/24/12.

  20. Erkan D, Harrison MJ, Levy R, et al. Aspirin for primary thrombosis prevention in the antiphospholipid syndrome: a randomized, double-blind, placebo-controlled trial in asymptomatic antiphospholipid antibody-positive individuals. Arthritis Rheum. 2007;56:2382–91.

    Article  PubMed  CAS  Google Scholar 

  21. Arnaud L, Mathian A, Ruffatti A, et al. Efficacy of aspirin for the prevention of the first thrombo-embolic events in patients with antiphospholipid antibodies: a metanalysis of literature data. [abstract]. Arthritis Rheum. 2012;64 Suppl 10:2459.

    Google Scholar 

  22. •• Barbhaiya M, Erkan D. Primary thrombosis prophylaxis in antiphospholipid antibody–positive patients: where do we stand? Curr Rheumatol Rep. 2011;13:59–69. This review discusses the risk of first thrombosis and prevention strategies in aPL-positive patients with no previous thrombosis.

    Article  PubMed  CAS  Google Scholar 

  23. •• Branch W. Report of the obstetric APS task force: 13th International Congress on Antiphospholipid Antibodies, 13 April 2010. Lupus. 2011;20:158. This paper summarizes areas of controversy and uncertainty and suggestions for future studies in obstetric APS as identified by the Obstetric APS Task Force of the 13th International Congress in 2010.

    Article  PubMed  CAS  Google Scholar 

  24. Rai R, Cohen H, Dave M, Regan L. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). BMJ. 1997;314:253–7.

    Article  PubMed  CAS  Google Scholar 

  25. Kutteh WH. Antiphospholipid antibody-associated recurrent pregnancy loss: treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone. Am J Obstet Gynecol. 1996;174:1584–9.

    Article  PubMed  CAS  Google Scholar 

  26. Branch DW. Antiphospholipid antibodies and fetal compromise. Thromb Res. 2004;114:415–8.

    Article  PubMed  CAS  Google Scholar 

  27. Meroni PL, di Simone N, Testoni C, et al. Antiphospholipid antibodies as cause of pregnancy loss. Lupus. 2004;13:649–52.

    Article  PubMed  CAS  Google Scholar 

  28. Derksen RH, de Groot PG. The obstetric antiphospholipid syndrome. J Reprod Immunol. 2008;77:41–50.

    Article  PubMed  CAS  Google Scholar 

  29. Tincani A, Bazzani C, Zingarelli S, Lojacono A. Lupus and the antiphospholipid syndrome in pregnancy and obstetrics: clinical characteristics, diagnosis, pathogenesis, and treatment. Semin Thromb Hemost. 2008;34:267–73.

    Article  PubMed  CAS  Google Scholar 

  30. Ruffatti A, Calligaro A, Hoxha A, et al. Laboratory and clinical features of pregnant women with antiphospholipid syndrome and neonatal outcome. Arthritis Care Res. 2010;62:302–7.

    Article  CAS  Google Scholar 

  31. Ruffatti A, Tonello M, Visentin MS, et al. Risk factors for pregnancy failure in patients with anti-phospholipid syndrome treated with conventional therapies: a multicentre, case–control study. Rheumatology (Oxford). 2011;50:1684–9.

    Article  CAS  Google Scholar 

  32. Ruffatti A, Tonello M, Del Ross T, et al. Antibody profile and clinical course in primary antiphospholipid syndrome with pregnancy morbidity. Thromb Haemost. 2006;96:337–41.

    PubMed  CAS  Google Scholar 

  33. Do Prado AD, Piovesan DM, Staub HL, Horta BL. Association of anticardiolipin antibodies with preeclampsia: a systematic review and meta-analysis. Obstet Gynecol. 2010;116:1433–43.

    Article  PubMed  Google Scholar 

  34. Al-Mishari AA, Gader AG, Al-Jabbari AW, et al. The prevalence of lupus anticoagulant in normal pregnancy and in women with recurrent fetal loss: recommendations for laboratory testing for lupus anticoagulant. Ann Saudi Med. 2004;24:429–33.

    PubMed  Google Scholar 

  35. •• Lockshin MD, Kim M, Laskin CA, et al. Prediction of adverse pregnancy outcome by the presence of lupus anticoagulant, but not anticardiolipin antibody, in patients with antiphospholipid antibodies. Arthritis Rheum. 2012;64:2311–8. This multi-center, prospective study of risk factors for adverse pregnancy outcome among women with aPL and/or SLE demonstrates lupus anticoagulant is the primary predictor of adverse pregnancy outcome after 12 weeks’ gestation in aPL-associated pregnancies.

    Article  PubMed  CAS  Google Scholar 

  36. Alijotas-Reig J, Ferrer-Oliveras R, Rodrigo-Anoro MJ, et al. Anti-β(2)-glycoprotein-I and anti-phosphatidylserine antibodies in women with spontaneous pregnancy loss. Fertil Steril. 2010;93:2330–6.

    Article  PubMed  CAS  Google Scholar 

  37. Agostinis C, Biffi S, Garrova C, et al. In vivo distribution of (β)2 glycoprotein I under various pathophysiologic conditions. Blood. 2011;118:4231–8.

    Article  PubMed  CAS  Google Scholar 

  38. Asherson RA. The catastrophic antiphospholipid syndrome. J Rheumatol. 1992;19:508–12.

    PubMed  CAS  Google Scholar 

  39. Asherson RA, Cervera R, de Groot PR, et al. Catastrophic antiphospholipid syndrome: international consensus statement on classification criteria and treatment guidelines. Lupus. 2003;12:530–4.

    Article  PubMed  CAS  Google Scholar 

  40. Erkan D, Cervera R, Asherson RA. Catastrophic antiphospholipid syndrome: where do we stand? Arthritis Rheum. 2003;48(12):3320–7.

    Article  PubMed  Google Scholar 

  41. •• Erkan D, Espinosa G, Cervera R. Catastrophic antiphospholipid syndrome: update diagnostic algorithms. Autoimmun Rev. 2010;10:74–9. This paper summarizes diagnostic challenges and proposes updated diagnostic algorithms for CAPS.

    Article  PubMed  Google Scholar 

  42. Kitchens CS. Thrombotic storm: when thrombosis begets thrombosis. Am J Med. 1998;104:381–5.

    Article  PubMed  CAS  Google Scholar 

  43. •• Kitchens CS, Erkan D, Brandao LR, et al. Thrombotic storm revisited: preliminary diagnostic criteria suggested by the thrombotic storm study group. Am J Med. 2011;124(4):290–6. This review article provides insight into the diagnosis and management of the “thrombotic storm” through a series of case presentations.

    Article  PubMed  Google Scholar 

  44. Connolly SJ, Ezekowitz MD, Yusuf S, et al. RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139–51.

    Article  PubMed  CAS  Google Scholar 

  45. •• Patel MR, Mahaffey KW, Gar J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation (and supplementary appendix). N Engl J Med. 2011;365:883–91. This study demonstrated that among patients with atrial fibrillation, rivaroxaban was not inferior to warfarin for prevention of stroke or systemic embolism.

    Article  PubMed  CAS  Google Scholar 

  46. Erikkson BI, Dahl OE, Rosencher N, RE-MODEL Study Group, et al. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the Re-MODEL randomized trial. J Thromb Haemost. 2007;5:2178–85.

    Article  Google Scholar 

  47. Eriksson BI, Dahl OE, Rosencher N, RE-NOVATE Study group, et al. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial. Lancet. 2007;370:949–56.

    Article  PubMed  CAS  Google Scholar 

  48. Eriksson BI, Borris LC, Dahl OE, RECORD 2 Investigators, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med. 2008;358:2765–75.

    Article  PubMed  CAS  Google Scholar 

  49. Kakkar AK, Brenner B, Dahl OE, RECORD 2 Investigators, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind randomised controlled trial. Lancet. 2008;372:31–9.

    Article  PubMed  CAS  Google Scholar 

  50. Lassen MR, Ageno W, Borris LC, RECORD 3 Investigators, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med. 2008;358:2776–86.

    Article  PubMed  CAS  Google Scholar 

  51. Turpie AG, Lassen MR, Davidson BL, RECORD 4 Investigators, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee replacement (RECORD 4): a randomised trial. Lancet. 2009;373:1673–80.

    Article  PubMed  CAS  Google Scholar 

  52. EINSTEIN Investigators, Bauersachs R, Berkowitz SD, Brenner B, et al. Oral rivaroxaban for symptomatic venous thromboembolism (and supplementary appendix). N Engl J Med. 2010;363:2499–510.

    Article  PubMed  CAS  Google Scholar 

  53. •• EINSTEIN–PE Investigators, Büller HR, Prins MH, Lensin AW, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012;366(14):1287–97. This randomized, open-label, noninferiority trial demonstrated that a fixed-dose regimen of rivaroxaban alone was not inferior to standard therapy for initial and long-term treatment of pulmonary embolism with a potentially improved benefit–risk profile.

    Article  PubMed  Google Scholar 

  54. Pierangeli SS, Vega-Ostertag ME, González EB. New targeted therapies for treatment of thrombosis in antiphospholipid syndrome. Expert Rev Mol Med. 2007;9:1–15.

    Article  PubMed  Google Scholar 

  55. Rand JH, Wu XX, Quinn AS, et al. Hydroxychloroquine directly reduces the binding of antiphospholipid antibody-beta2-glycoprotein I complexes to phospholipid bilayers. Blood. 2008;112:1687–95.

    Article  PubMed  CAS  Google Scholar 

  56. Johnson R, Charnley J. Hydroxychloroquine in prophylaxis of pulmonary embolism following hip arthroplasty. Clin Orthop Relat Res. 1979;144:174–7.

    PubMed  Google Scholar 

  57. Petri M. Lupus in Baltimore: evidence-based “clinical pearls” from the Hopkins Lupus Cohort. Lupus. 1995;14:970–3.

    Article  Google Scholar 

  58. Ruiz-Irastorza G, Egurbide MV, Pijoan JI, et al. Effect of antimalarials on thrombosis and survival in patients with systemic lupus erythematosus. Lupus. 2006;15:577–83.

    Article  PubMed  CAS  Google Scholar 

  59. Kaiser R, Cleveland CM, Criswell LA. Risk and protective factors for thrombosis in systemic lupus erythematosus: results from a large, multi-ethnic cohort. Ann Rheum Dis. 2009;68:238–41.

    Article  PubMed  CAS  Google Scholar 

  60. Erkan D, Yazici Y, Peterson MG, et al. A cross-sectional study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome. Rheumatology (Oxford). 2002;41:924–9.

    Article  CAS  Google Scholar 

  61. Jung H, Bobbo R, Su J, et al. The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosus. Arthritis Rheum. 2010;62:863–8.

    Article  PubMed  CAS  Google Scholar 

  62. Ho KT, Ahn CW, Alarcon GS, et al. Systemic lupus erythematosus in a multiethnic cohort (LUMINA): XXVIII. Factors predictive of thrombotic events. Rheumatology. 2005;44:1303–7.

    Article  PubMed  CAS  Google Scholar 

  63. Mok CC, Tang SS, To CH, et al. Incidence and risk factors of thromboembolism in systemic lupus erythematosus: a comparison of three ethnic groups. Arthritis Rheum. 2005;52:2774–82.

    Article  PubMed  Google Scholar 

  64. Pierangeli SS, Colden-Stanfield M, Liu X, et al. Antiphospholipid antibodies from antiphospholipid syndrome patients activate endothelial cells in vitro and in vivo. Circulation. 1999;99:1997–2002.

    Article  PubMed  CAS  Google Scholar 

  65. Ferrara DE, Swerlick R, Casper K, et al. Fluvastatin inhibits up-regulation of tissue factor expression by antiphospholipid antibodies on endothelial cells. J Thromb Haemost. 2004;2:1558–63.

    Article  PubMed  CAS  Google Scholar 

  66. Girardi G. Pravastatin prevents miscarriages in antiphospholipid antibody-treated mice. J Reprod Immunol. 2009;82:126–31.

    Article  PubMed  CAS  Google Scholar 

  67. Ferrara DE, Liu X, Espinola RG. Inhibition of the thrombogenic and inflammatory properties of antiphospholipid antibodies by fluvastatin in an in vivo animal model. Arthritis Rheum. 2003;48:3272–9.

    Article  PubMed  CAS  Google Scholar 

  68. Meroni PL, Raschi E, Testoni C. Statins prevent endothelial cell activation induced by antiphospholipid (anti-beta2- glycoprotein I) antibodies: effect on the proadhesive and proinflammatory phenotype. Arthritis Rheum. 2001;44:2870–8.

    Article  PubMed  CAS  Google Scholar 

  69. Ferrara DE, Swerlick R, Casper K. Fluvastatin inhibits up-regulation of tissue factor expression by antiphospholipid antibodies on endothelial cells. J Thromb Haemost. 2004;2:1558–63.

    Article  PubMed  CAS  Google Scholar 

  70. Martinez-Martinez LA, Amigo MC, Orazco A, et al. Effect of rosuvastatin on VCAM-1 expression by HUVEC exposed to APS serum in an in vitro model. Clin Exp Rheumatol. 2007;25:18–9.

    Google Scholar 

  71. Ridker PM, Danielson E, Fonseca FA, et al. JUPITER Trial Study Group. Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial. Lancet. 2009;373:1175–82.

    Article  PubMed  CAS  Google Scholar 

  72. Glynn RJ, Danielson E, Foseca FA, et al. A randomized trial of rosuvastatin in the prevention of venous thromboembolism. N Engl J Med. 2009;360:1851–61.

    Article  PubMed  CAS  Google Scholar 

  73. Cuadrado MJ, Lopez-Pedrera C, Aguirre A, et al. Changes operated in protein pattern of monocytes from patients with antiphospholipid syndrome treated with statins. Arthritis Rheum. 2007;56:S782–3.

    Google Scholar 

  74. Murthy VL, Erkan D, Jajoria P, et al. Effects of fluvastatin on pro-inflammatory and pro-thrombotic markers in antiphospholipid antibody (aPL)-positive patients: preliminary results from an open-label prospective pilot study [abstract]. Arthritis Rheum. 2011;63 Suppl 10:726.

    Google Scholar 

  75. •• Pierangeli S, Erkan D. Antiphospholipid syndrome treatment beyond anticoagulation: are we there yet? Lupus. 2010;19(4):475–85. This review article addresses the experimental and/or clinical evidence behind some of the potential “immunomodulatory” approaches to treatment of APS.

    Article  PubMed  CAS  Google Scholar 

  76. Rubenstein E, Arkfeld DG, Metyas S, et al. Rituximab treatment for resistant antiphospholipid syndrome. J Rheumatol. 2006;33(2):355–7.

    PubMed  Google Scholar 

  77. Manner H, Jung B, Tonassi L, et al. Successful treatment of catastrophic antiphospholipid antibody syndrome (CAPS) associated with splenic marginal-zone lymphoma with low-molecular weight heparin, rituximab and bendamustine. Am J Med Sci. 2008;335(5):394–7.

    Article  PubMed  Google Scholar 

  78. van Wissen S, Bastiaansen BA, Stroobants AK, et al. Catastrophic antiphospholipid syndrome mimicking a malignant pancreatic tumour – a case report. Lupus. 2008;17:586–90.

    Article  PubMed  Google Scholar 

  79. Nageswara Rao AA, Arteaga GM, Reed AM, et al. Rituximab for successful management of probable pediatric catastrophic antiphospholipid syndrome. Pediatr Blood Cancer. 2009;52:536–8.

    Article  PubMed  Google Scholar 

  80. Jamoussi SK, Zaghdoudi I, Ben Dhaou B, et al. Catastrophic antiphospholipid syndrome and rituximab: a new report. Tunis Med. 2009;87:699–702.

    Google Scholar 

  81. Iglesias-Jiménez E, Camacho-Lovillo M, Falcón-Neyra D, et al. Infant with probable catastrophic antiphospholipid syndrome successfully managed with rituximab. Pediatrics. 2010;125:e1523–8.

    Article  PubMed  Google Scholar 

  82. Haque W, Kadikoy H, Pacha O, et al. Osteonecrosis secondary to antiphospholipid syndrome: a case report, review of the literature, and treatment strategy. Rheumatol Int. 2010;30:719–23.

    Article  PubMed  Google Scholar 

  83. •• Erkan D, Vega J, Ramon G, et al. A pilot open-label phase II trial of rituximab for non-criteria manifestations of antiphospholipid syndrome. Arthritis Rheum. 2013;65:464–71. This pilot study suggests that rituximab may be effective in controlling some but not all non-criteria manifestations of APS.

    Article  PubMed  CAS  Google Scholar 

  84. Girardi G, Redecha P, Salmon JE. Heparin prevents antiphospholipid antibody-induced fetal loss by inhibiting complement activation. Nat Med. 2004;10:1222–6.

    Article  PubMed  CAS  Google Scholar 

  85. •• Shapira I, Andrade D, Allen SL, Salmon JE. Brief report: induction of sustained remission in recurrent catastrophic antiphospholipid syndrome via inhibition of terminal complement with eculizumab. Arthritis Rheum. 2012;64:2719–23. This paper describes the first use of eculizumab for treatment of acute catastrophic APS.

    Article  PubMed  CAS  Google Scholar 

  86. Velik-Salchner C, Lederer W, Wiedermann F. Eculizumab and renal transplantation in a patient with catastrophic antiphospholipid syndrome: effect of heparin on complement activation. Lupus. 2011;20:772.

    Article  PubMed  CAS  Google Scholar 

  87. Hadaya K, Ferrari-Lacraz S, Fumeaux D, et al. Eculizumab in acute recurrence of thrombotic microangiopathy after renal transplantation. Am J Transplant. 2011;11:2523–7.

    Article  PubMed  CAS  Google Scholar 

  88. Canaud G, Kamar N, Anglicheau D et al.; Eculizumab Improves Posttransplant Thrombotic Microangiopathy Due to Antiphospholipid Syndrome Recurrence but Fails to Prevent Chronic Vascular Changes. Am J Transplant. 2013;13:2179–85.

    Google Scholar 

  89. Lonze BE, Singer AL, Montgomery RA. Eculizumab and renal transplantation in a patient with CAPS. N Engl J Med. 2010;362(18):1744–5.

    Article  PubMed  CAS  Google Scholar 

  90. •• Erkan D, Derksen R, Levy R, et al. Antiphospholipid syndrome clinical research task force report. Lupus. 2011;20:219–24. This paper reports the findings and recommendations of the Antiphospholipid Syndrome (APS) Clinical Research Task Force developed by the 13th International Congress on Antiphospholipid Antibodies organization committee meeting in 2010 to evaluate the limitations of APS clinical research, develop guidelines for researchers to help improve the quality of research, and prioritize a well-designed multicenter APS clinical trial.

    Article  PubMed  CAS  Google Scholar 

  91. •• Erkan D, Lockshin MD. APS action—antiphospholipid syndrome alliance for clinical trials and international networking. Lupus. 2012;21:695–8. This paper describes the formation of the Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION), the first-ever international research network created specifically to design and conduct well-designed, large-scale, multi-center clinical trials in persistently antiphospholipid antibody-positive patients.

    Article  PubMed  CAS  Google Scholar 

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Conflict of Interest

Doruk Erkan has served as a consultant for Alexion, has received grant support from the Lupus Clinical Trials Consortium, the New York Community Trust, and Genentech, has received payment for development of educational presentations (including service on speakers bureaus) from GlaxoSmithKline, has served as a multicenter clinical trial investigator for Eli Lilly and Company, and has served as APS ACTION executive committee chair. Medha Barbhaiya declares that she has no conflict of interest.

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This article is part of the Topical Collection on Systemic Lupus Erythematosus

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Barbhaiya, M., Erkan, D. Top 10 Clinical Research Developments in Antiphospholipid Syndrome. Curr Rheumatol Rep 15, 367 (2013). https://doi.org/10.1007/s11926-013-0367-6

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