Triple positive profile in antiphospholipid syndrome: prognosis, relapse and management from a retrospective multicentre study
Arsène Mekinian,
Laure Ricard,
Olivier Fain,
Claire de Moreuil,
Eric Rondeau,
Yann Nguyen,
Cathererine Johanet,
Charlotte Laurent,
Sophie Deriaz,
Grigorios Gerotziafas,
Ismail Elalamy,
Jean Jacques Boffa,
Virginie Planche,
Francois Millot
Affiliations
Arsène Mekinian
10 Internal Medicine, Hospital Saint-Antoine, Paris, Île-de-France, France
Laure Ricard
Sorbonne Université, AP-HP, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Hôpital Saint-Antoine, F-75012, Paris, France
Olivier Fain
Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France, French Armenian research center, Erevan, Armenia
Claire de Moreuil
Service de médecine interne, Centre hospitalier et universitaire Brest, Brest, France
Eric Rondeau
Service des urgences néphrologiques et transplantation rénale, Hôpital Tenon, Paris, France
Yann Nguyen
Service de médecine médecine interne, AP-HP.Nord, Hôpital Beaujon, Université de Paris, Clichy, France
Cathererine Johanet
Immunology Department, Saint-Antoine Hospital Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
Charlotte Laurent
Sorbonne Université, AP-HP, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Hôpital Saint-Antoine, F-75012, Paris, France
Sophie Deriaz
Service de médecine interne, Centre hospitalier et universitaire Bretonneau, Tours, France
Grigorios Gerotziafas
Service d’hématologie biologique, Hôpital Tenon, Paris, France
Ismail Elalamy
Service d’hématologie biologique, Hôpital Tenon, Paris, France
Jean Jacques Boffa
Service de Néphrologie et dialyses, Hôpital Tenon, Paris, France
Virginie Planche
Sorbonne Université, Service de Hématologie biologique, AP-HP, Hôpital Saint-Antoine, 75012, Paris, France
Francois Millot
Service de médecine interne, Centre hospitalier et universitaire Bretonneau, Tours, France
Objective Antiphospholipid syndrome (APS) is defined by the association of thromboembolic and/or obstetrical clinical manifestations and the presence of antiphospholipid antibodies. The objective of our study was to evaluate the impact of the triple-positive profile in a cohort of 204 APS patients.Methods We conducted a retrospective study, including patients with primary or secondary APS, meeting the Sydney criteria with at least one thrombotic and/or obstetrical complication. Clinical characteristics and the risk of relapse (defined by the occurrence of a new thrombotic event and/or a new adverse obstetrical event) between triple-positive and non-triple-positive APS patients were compared.Results 204 patients were included in our study, 68 were triple-positive and 136 were single or double positive. 122 patients (59.8%) had primary APS. 67 patients (32.8%) had obstetrical APS, with a higher rate among triple-positive patients (45.6% vs 26.5%, p=0.010), and 170 patients (83.3%) had thrombotic APS, without difference between triple-positive and others. Thrombotic events were more often venous (56.4%) than arterial (37.7%). Triple-positive patients had more placental complications than others (17.6% vs 2.9%, p=0.001) and more non-criteria events (48.5% vs 25.7%, p=0.002). Among non-criteria events, there was a higher frequency of Sneddon syndrome in triple-positive patients (7.4% vs 0.7%, p=0.028). The relapse rate was higher in triple-positive patients than in others (63.2% vs 39,7%, p=0002). In multivariate analysis, the triple-positive profile was associated with a higher risk of relapse (HR 1.63; 95% CI 1.04 to 2.55; p=0.031).Conclusion The triple-positivity is associated with a higher risk of relapse and obstetrical complications.
