Year: 2014
Type: conference-abstract
Abstract: Women with anti-SSA/Ro and a previous child with heart block have a 15–20% risk of recurrence in a subsequent pregnancy. A previous case control study suggested that the use of HCQ might prevent the development of cardiac Neonatal Lupus (cardiac NL) in anti-SSA/Ro antibody-exposed fetuses of SLE mothers. In a subsequent study the use of HCQ reduced the recurrence rate of cardiac NL in an international cohort study of anti-SSA/Ro women. Based on these data, we began an open label prospective study to evaluate whether HCQ reduces the recurrence rate of cardiac NL. We used a Simon's two-stage approach to allow for early stopping due to absence of treatment efficacy. In the first stage 19 anti-SSA/Ro ab pregnant patients with a previous child with cardiac NL (1st degree block excluded) were enrolled and if 3 or more children with cardiac NL were born, the study would be terminated for inefficacy. HCQ had to be initiated before 10 weeks gestation. Serial fetal echos were used to evaluate for the development of the primary (2° or 3° block) and secondary (1st degree block) outcomes. A total of 32 mothers have been enrolled in Stage 1 and the beginning of Stage 2. Seventeen women have completed 23 pregnancies. There have been 21 pregnancies resulting in 22 neonates have had normal outcomes. One fetus developed 3° heart block at 20 weeks. Another pregnancy resulted in a secondary outcome of a prolonged fetal PR interval > 150 msec at 26 weeks for which the mother was treated with 3 days of 4mg dexamethasone with resolution and a normal EKG at birth. Two additional ongoing pregnancies are beyond 24 weeks (the most vulnerable period for complete block is 18-24 weeks). Overall, the rate of recurrence of cardiac NL is currently 1/25 (4%). These prospective data affirm that HCQ may reduce the recurrence of cardiac NL to a number well below that expected from prior studies.
DOI: 10.1002/uog.13489
Authors: J.A. Copel, P. Izminly, N. Costedoat‐Chalumeau, A. Saxena, A. Zinc, T. Middleton, D. Friedman, J.P. Buyon
Institutions: Yale University, NYU Langone Health, Hôpital Cochin
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2029470674