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Triple-therapy regimen associated with improved survival in catastrophic antiphospholipid syndrome

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MADRID — A triple regimen of anticoagulation therapy, corticosteroids and plasma exchange and/or immunoglobulins was associated with reduced mortality among patients with catastrophic antiphospholipid syndrome, according to findings presented at the EULAR Annual Congress.

“Triple therapy showed to be independently associated to a higher survival rate in [catastrophic antiphospholipid syndrome] CAPS,” Ignasi Rodriguez-Pinto, MD, of the Department of Autoimmune Disease at the Hospital Clinic at Barcelona University in Spain, said.

Data for 525 episodes in 502 patients were accrued from the CAPS registry. The study included 197 patients treated with the triple regimen, 278 patients treated with some other combination of the three therapies and 12 patients who were received no therapy. Clinicians prescribed triple therapy in 40.5% of episodes that underwent analysis, another combination in 57.1% of episodes and no treatment for 2.5% of episodes.

The overall mortality rate for the cohort was 36%, according to Rodriguez-Pinto. However, patients in the triple-therapy group had a mortality rate of 27.9% compared with 40.6% in those treated with some combination of those drugs and 75% for patients who went untreated. Compared with no treatment, the triple regimen yielded a significantly higher chance of survival (adjusted odds ratio [OR] = 7.7). A similar trend in survival persisted for the comparison between no treatment or some combination vs. triple therapy (adjusted OR = 6.8).

“This was a 47% decrease in mortality rate” for the triple regimen compared with other treatment strategies, Rodriguez-Pinto said.

He noted that demographic information, such as age, gender and systemic lupus erythematosus parameters, were similar across the three study groups, as were cardiac, neurological and renal involvement.

Data heterogeneity in the CAPS registry limits this study, along with publication bias, according to Rodriguez-Pinto. However, he cited the large cohort and endpoint as strengths of the analysis. — by Rob Volansky

Reference:

Rodriguez-Pinto I, et al. Abstract #OP0231. Presented at: EULAR Annual Congress; June 14-17, 2017; Madrid.

Disclosure: Rodriguez-Pinto reports no relevant financial disclosures.