Intravenous immunoglobulin therapy in pregnant patients affected with systemic lupus erythematosus and recurrent spontaneous abortion

Objectives. We aimed to test the maternal and fetal outcome of SLE patients who suffered from recurrent spontaneous abortion (RSA) treated with intravenous immunoglobulin (IVIg) alone during pregnancy and whether the clinical response to IVIg treatment is accompanied by modifications of SLE-associat...

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Bibliographic Details
Published in:Rheumatology (Oxford, England) England), 2008-05, Vol.47 (5), p.646-651
Main Authors: Perricone, R., De Carolis, C., Kröegler, B., Greco, E., Giacomelli, R., Cipriani, P., Fontana, L., Perricone, C.
Format: Article
Language:English
Subjects:
Abortion, Habitual - immunology
Abortion, Habitual - therapy
Adult
Analysis of Variance
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Antibodies, Anticardiolipin - blood
Antibodies, Antinuclear - immunology
APS
Aspirin - therapeutic use
Autoantibodies - blood
Biological and medical sciences
Complement C3 - analysis
Complement C4 - analysis
Diseases of mother, fetus and pregnancy
Diseases of the osteoarticular system
DNA - immunology
Female
Gynecology. Andrology. Obstetrics
Humans
Immunization, Passive - methods
Immunoglobulins, Intravenous
Immunosuppressive Agents - therapeutic use
IVIg
Lupus Erythematosus, Systemic - immunology
Lupus Erythematosus, Systemic - therapy
Medical sciences
Prednisolone - therapeutic use
Pregnancy
Pregnancy Outcome
Pregnancy. Fetus. Placenta
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
SLE
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Summary:Objectives. We aimed to test the maternal and fetal outcome of SLE patients who suffered from recurrent spontaneous abortion (RSA) treated with intravenous immunoglobulin (IVIg) alone during pregnancy and whether the clinical response to IVIg treatment is accompanied by modifications of SLE-associated antibodies and of complement levels. Methods. Twelve SLE-RSA pregnant patients were treated with high-dose IVIg and compared with 12 SLE-RSA pregnant patients treated with prednisolone and NSAIDs. They were evaluated for the clinical response [lupus activity index-pregnancy (LAI-P) scale] and for ANA, anti-dsDNA, anti Ro/SS-A or La/SS-B, aCL, LAC, C4, C3 before and during pregnancy, and before and after each treatment course. Pregnancy outcome in the two groups was also evaluated. Results. The groups characteristics were homogeneous at the beginning of pregnancy. A beneficial clinical response following IVIg treatment was noted in all patients and mean LAI-P decreased from 0.72 ± 0.43 at the beginning of pregnancy to 0.13 ± 0.19 at the end of pregnancy (P < 0.0001). Antibodies and complement levels tended to normalize in most of the patients. These clinical and laboratory improvements were significant with respect to the control group. Pregnancy was successfully carried out in 12/12 (100%) SLE-RSA patients with a mean Apgar score of 8.92. Three patients in the control group got aborted (25%). Conclusions. IVIg has a high response rate among SLE-RSA pregnant patients and may be considered safe and effective.
ISSN:1462-0324
1462-0332
DOI:10.1093/rheumatology/ken046