SAT0633 PREGNANCY SUCCESS RATE AND RESPONSE TO HEPARINS AND/OR ASPIRIN DIFFERS IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS ACCORDING TO THE GAPSS SCORE
Authors: Massimo Radin, Irene Cecchi, Karen Schreiber, Elena Rubini, Savino Sciascia, Dario Roccatello
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Current standard of care (SoC) in pregnancy for patients with Systemic lupus erythematosus (SLE) and/or aPL positivity includes treatment with low dose aspirin (75–100mg/day) and low molecular heparin or unfractionated heparin. However, up to 30% of women continue to have pregnancy complications despite SoC. Therefore, identifying patients that are at greater risk to develop pregnancy complications despite the SoC and might benefit from additional therapeutic approaches, is still an unmet clinical need. Recently, our group conceived and validated the global antiphospholipid syndrome score (GAPSS) [1], as a risk score for predicting aPL-related clinical manifestations (thrombotic and/or pregnancy morbidity). <h3>Objectives</h3> We aimed to investigate response to SoC in women with SLE and/or aPL positivity when stratifying their risk according to GAPSS Score. <h3>Methods</h3> 143 women ever pregnant treated with SoC therapy with SLE and/or aPL positivity were included. Data on cardiovascular risk factors and aPL positivity were retrospectively collected. The individual GAPSS was calculated for each patient by calculating the sum of each risk factor score, as follows: 3 for hyperlipidaemia, 1 for arterial hypertension, 5 for anticardiolipin IgG/IgM, 4 for anti-β2glycoprotein I IgG/IgM, 3 for anti-phosphatidylserine/prothrombin antibodies IgG/IgM and 4 for lupus anticoagulant. The patients GAPSS was then grouped according to the patients' GAPSS into low risk (&lt;6), medium risk (6-11) and high risk (≥12). <h3>Results</h3> The analysis included 143 patients (mean age 30.8 ±6.4) with SLE (122; 85.3%) and/or aPL positivity, for a total of 352 pregnancies. Overall, we observed a live birth rate of 70.5%, with a total of live birth of 248 out of the 352 pregnancies. Forty-five patients (31%) experienced at least one event of PM, defined as early or late. When considering patients who ever experienced PM while treated with SoC, all patients in the high risk group (GAPSS≥12) experienced PM, while patients in the medium group (GAPSS 6-11) had a significant higher rate of PM when compared to the low risk (GAPPS &lt;6) group [29 (43.9%) patients V.s. 11 (15.3%), respectively; p&lt;0.001]. When analysing the number of pregnancies in the three groups, patients in the high risk group had significantly lower live birth rates, when compared to the other groups [11(40.7%) life births V.s. 100(62.1%) and 137(82.5%), respectively; p&lt;0.05]. Furthermore, patients with medium risk group also had significantly lower live birth rates, when compared to the lower risk group (p&lt;0.001). Figure 1 resumes the results of PM and live births divided in the three groups. <h3>Conclusion</h3> GAPSS might be a valuable tool for identifying patients with a higher likelihood of response to SoC. <h3>References</h3> [1] Sciascia S, Sanna G, Murru V, Roccatello D, Khamashta MA, Bertolaccini ML. GAPSS: the Global Anti-Phospholipid Syndrome Score. Rheumatology (Oxford). 2013 Aug [cited 2016 Sep 21];52(8):1397–403. <h3>Disclosure of Interests</h3> None declared