Risk of thrombosis with anti-phospholipid syndrome in systemic lupus erythematosus treated with thrombopoietin-receptor agonists

• Published in: Rheumatology 2018-08, Vol.57 (8), p.1432-1438
• Main Authors: Guitton, Zelie, Terriou, Louis, Lega, Jean-Christophe, Nove-Josserand, Raphaele, Hie, Miguel, Amoura, Zahir, Bussel, James B, Hamidou, Mohamed, Rosenthal, Eric, Lioger, Bertrand, Chauveau, Dominique, Chaminade, Axel, Magy-Bertrand, Nadine, Michel, Marc, Audia, Sylvain, Godeau, Bertrand, Mahevas, Matthieu
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Agonists; Antiphospholipid syndrome; Antiphospholipid Syndrome - complications; Antiphospholipid Syndrome - diagnosis; Antiphospholipid Syndrome - drug therapy; Autoimmune diseases; Benzoates - administration & dosage; Benzoates - adverse effects; Drug development; Female; Follow-Up Studies; France - epidemiology; Humans; Hydrazines - administration & dosage; Hydrazines - adverse effects; Incidence; Life Sciences; Lupus; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - diagnosis; Lupus Erythematosus, Systemic - diagnostic imaging; Lupus Erythematosus, Systemic - drug therapy; Male; Middle Aged; Patients; Phospholipids; Prognosis; Pyrazoles - administration & dosage; Pyrazoles - adverse effects; Receptors, Fc - administration & dosage; Receptors, Thrombopoietin - antagonists & inhibitors; Recombinant Fusion Proteins - administration & dosage; Recombinant Fusion Proteins - adverse effects; Retrospective Studies; Systemic lupus erythematosus; Thrombopoietin; Thrombopoietin - administration & dosage; Thrombopoietin - adverse effects; Thrombosis; Thrombosis - chemically induced; Thrombosis - epidemiology; Thrombosis - etiology; Young Adult
• ISSN: 1462-0324; 1462-0332; 1460-2172
• DOI: 10.1093/rheumatology/key119

Abstract Objectives The use of thrombopoietin-receptor agonists (TPO-RAs) has increased as a second-line therapy in ITP, but the efficacy and safety of such drugs has not been evaluated in SLE-associated ITP. Methods This was a multicentre retrospective cohort study from 2009 to 2016. Participating centres (n = 11) were secondary- or tertiary-care hospitals belonging to the French national network for adult ITP. Results We included 18 patients with SLE-ITP treated with TPO-RAs; 10 (55%) had aPL, 5 (27%) showing definite APS. Except for one patient, all (94%) achieved response with TPO-RAs overall. After a median follow-up of 14.7 months with TPO-RAs, four arterial thrombosis events (including one catastrophic APS) occurred in four patients. Two venous thrombosis events occurred in a patient without APS or aPLs. Conclusion Our results suggest that aPLs should be systematically screened before TPO-RA initiation in patients with SLE. With aPL positivity, alternative therapy should be discussed (if possible), especially in patients with definite APS or suboptimal adherence to anti-coagulation therapy.