The effect of triple therapy on the mortality of catastrophic anti-phospholipid syndrome patients. (11th April 2018)

• Record Type: Journal Article
• Authors: Rodríguez-Pintó, Ignasi; Espinosa, Gerard; Erkan, Doruk; Shoenfeld, Yehuda; Cervera, Ricard
• Is Part Of: Rheumatology. Volume 57:Number 7(2018)
• Page Start: 1264
• Page End: 1270
• Publication Date: 2018-04-11
• Subjects: catastrophic antiphospholipid syndrome -- antiphospholipid syndrome -- mortality -- survival rate -- treatment -- systemic lupus erythematosus -- triple therapy -- plasma exchange -- immunoglobulins; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/key082
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objectives: The objective of this study was to assess the effect that triple therapy (anticoagulation plus CS plus plasma exchange and/or IVIGs) has on the mortality risk of patients with catastrophic APS (CAPS) included in the CAPS Registry. Methods: Patients from the CAPS Registry were grouped based on their treatments: triple therapy; drugs included in the triple therapy but in different combinations; and none of the treatments included in the triple therapy. The primary endpoint was all-cause mortality. Multivariate logistic regression models were used to compare mortality risk between groups. Results: The CAPS Registry cohort included 525 episodes of CAPS accounting for 502 patients. After excluding 54 episodes (10.3%), a total of 471 patients with CAPS were included [mean (s .d .) age 38.5 years (17); 68.2% female; primary APS patients 62%]. Overall, 174 (36.9%) patients died. Triple therapy was prescribed in 189 episodes (40.1%), other combinations in 270 (57.3%) and none of those treatments in 12 episodes (2.5%); the mortality rate in the three groups was 28.6, 41.1 and 75%, respectively. Triple therapy was positively associated with a higher chance of survival when compared with non-treatment [adjusted odds ratio (OR) = 9.7, 95% CI: 2.3, 40.6] or treatment with other combinations of drugs included in the triple therapy (adjusted OR = 1.7, 95% CI: 1.2, 2.6). No statistical differences were found between patients that received triple therapy with plasma exchange or IVIGs ( P = 0.92). Conclusion: Triple therapy is independently associated with a higher survival rate among patients with CAPS.