Preventing first thrombosis remains top unmet need in antiphospholipid syndrome
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SAN DIEGO — Preventing the first thrombosis, and better circumvention of the second, are currently the biggest obstacles in managing antiphospholipid syndrome, according to a speaker at the 2024 Congress of Clinical Rheumatology West.
“I think the biggest treatment challenge is primary prevention,” Richard A. Furie, MD, chief of the rheumatology division at Northwell Health, in New York, told attendees, adding that “safe and convenient secondary prevention is certainly also on the list” of drug development needs. “You know the patient has these antibodies — what do you do?”
Noting a roughly 5% chance each year that a patient with antiphospholipid syndrome will experience his or her first thrombosis, Furie highlighted inadequacies with the current go-to prophylactic — aspirin.
Though easy and common to prescribe, a study by Doruk Erkan, MD, and colleagues saw three thrombotic complications in patients given aspirin and none in the placebo arm, according to Furie.
“Are we treating the patient, or are we treating the doctor?” he said.
Furie granted that preventing a second clot is “a little easier,” as anti-coagulation with warfarin is usually “quite effective.” However, this is still burdensome and does not always work, he said.
“Following patients on warfarin, that’s a pain in the neck for you and the patient,” Furie said, adding there are “occasional patients who are refractory to warfarin.”
In those cases, “you’re on your own,” Furie said. However, among the various alternatives, he reported a preference for complement inhibition.
According to Furie, the difficulties of conducting research in this area abound.
“The event rate for thrombosis, even off therapy, is very low,” he said. “With a very low event rate, you need either a ton of patients, or to follow these patients for a really long time. Then, if you have patients who are on some kind of anti-coagulant therapy, the event rate is really low.”
Furie concluded by warning attendees that antiphospholipid syndrome is “far more common a syndrome than you might think,” and there is “not a subspecialty that might not be affected” by it.
“We do need primary prevention therapy [and] we need more convenient secondary prevention therapy,” he said. “However, how to study all this is incredibly challenging.”
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Furie RA. Antiphospholipid Syndrome: It’s Far More Than You Think. Presented at The Congress of Clinical Rheumatology West; Sept. 26-29, 2024. (hybrid meeting).
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