16th International Congress on Antiphospholipid Antibodies Task Force Report on Antiphospholipid Syndrome Treatment Trends

Abstract

Antiphospholipid syndrome (APS), an acquired autoimmune thrombophilia, is characterised by thrombosis and/or pregnancy morbidity in association with persistent antiphospholipid antibodies. The 16th International Congress on Antiphospholipid Antibodies Task Force on APS Treatment Trends reviewed the current status with regard to existing and novel treatment trends for APS, which is the focus of this Task Force report. The report addresses current treatments and developments since the last report, on the use of direct oral anticoagulants in patients with APS, antiplatelet agents, adjunctive therapies (hydroxychloroquine, statins and vitamin D), targeted treatment including rituximab, belimumab, and anti-TNF agents, complement inhibition and drugs based on peptides of beta-2-glycoprotein I. In addition, the report summarises potential new players, including coenzyme Q10, adenosine receptor agonists and adenosine potentiation. In each case, the report provides recommendations for clinicians, based on the current state of the art, and suggests a clinical research agenda. The initiation and development of appropriate clinical studies requires a focus on devising suitable outcome measures, including a disease activity index, an optimal damage index, and a specific quality of life index.

Keywords: Antiphospholipid syndrome; anti-β2-glycoprotein I peptides; biologics; complement inhibition; direct oral anticoagulants; potential new players.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: HC reports, outside the submitted work, institutional research support and support to attend scientific meetings from Bayer Healthcare, with honoraria for lectures from Bayer Healthcare and consultancy fees from UCB paid to University College London Hospitals Charity; DE reports, outside the submitted work, consulting fees from GSK, Exagen and UCB, and research support from American College of Rheumatology, European League Against Rheumatism, Lupus Clinical Trials Consortium, National Institute of Allergy and Infectious Disease, and GSK; JSK reports, outside the submitted work, funding from Jazz Pharmaceuticals for preclinical studies of defibrotide; TLO reports, outside the submitted work, consulting fees from Instrumentation Laboratory and research support from Instrumentation Laboratory and Siemens; AR is a co-inventor on a patent to develop PEGylated Domain I of beta-2-glycoprotein I as a novel therapy for APS; JE Salmon reports, outside the submitted work, support of an investigator-initiated grant form UCB and consultancy fees from Admirx, Akari, BMS, Realta, and UCB; MGT reports, outside the submitted work, consultant fees and unrestricted grants from AbbVie, MSD, Novartis, Pfizer, GSK and UCB deposited to the Special Account for Research Funding (ELKE) of the National and Kapodistrian University of Athens Medical School; SW reports, outside the submitted work, grant support from Bristol‐Meyers‐Squibb/Pfizer Alliance paid to Intermountain Healthcare, and service as co-chair for the American College of Chest Physicians panelists guideline update for the treatment of venous thromboembolism; DJW reports, outside the submitted work, being Chief Clinical investigator of the Stamp Trial; and current research funding from the UK Medical Research Council, Wellbeing of Women, Chief Scientist Office Scotland, Rosetrees Trust and EGA Charity. MJC, A D-G, DA, DAI and RW have nothing to disclose.