Oral and Poster Presentation ARA-NSW 2021 - 43rd Annual NSW Branch Meeting

Systematic review of the effectiveness of hydroxychloroquine and intravenous immunoglobulin to prevent cardiac neonatal lupus in offspring of women with autoantibodies to SSA/Ro & SSB/La. (#8)

Kiri Langford 1 , Louise Ward 2 , Franziska Pettit 3 4 , Allan Sturgess 1 , Marissa Lassere 1 4
  1. Department of Rheumatology, St George Hospital, Kogarah, NSW, Australia
  2. Department of Rheumatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
  3. Department of Renal Medicine, St George Hospital, Kogarah, NSW, Australia
  4. St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia

Introduction:

 Offspring of women with autoantibodies to Anti-SSA/Ro and/or Anti-SSB/La have a 1-2% chance of developing cardiac neonatal lupus (CNL) which may lead to congenital heart block, endocardial fibroelastosis or foetal demise 1. Hydroxychloroquine (HCQ) and intravenous immunoglobulin (IVIG) have been used during pregnancy to prevent CNL in the offspring of women with anti-SSA/Ro and Anti-SSB/La autoantibodies. We performed a systemic review of studies ascertaining the effectiveness of HCQ and IVIG taken during pregnancy in preventing CNL.

Methods and Analysis:

Population: Offspring of women with Anti SSA/Ro and SSB/La antibodies > 12 weeks’ gestation.

Interventions: Maternal exposure to HCQ or IVIG during pregnancy

Comparison: Standard of care

Outcome: CNL

Two authors (KL & LW) searched PubMed, Ovid Embase and Medline from database inception - December 2020.  One author (KL) searched CINAHL, Clinical Trials.gov, Cochrane databases from database inception (Dec 2020) and hand-searched relevant reference lists. The search strategy combined free text search terms, exploded MeSH/EMTREE terms, and all synonyms of the medical MeSH major topic terms. Women with rheumatic conditions without Anti SSA/Ro and SSB/La antibodies and pregnancy losses <12 weeks’ gestation were excluded. Case reports and series were excluded. If consensus for inclusion was not reached between 2 authors (KL & LW) a third author (ML) was consulted.

Results:  Two authors (KL & LW) screened 275 studies and performed full text review for 93 studies. 16 studied met criteria for data extraction. This systematic review suggests a benefit of HCQ during pregnancy in preventing CNL and little to no benefit of IVIG. Risk of bias assessment with the ROBINS-I tool 2 revealed most included studies had a serious risk of bias, therefore a meta-analysis was not performed. CNL was a rare event, even in this cohort of patients, and this limited the use of odds and risk ratios.

  1. Wainwright B, Bhan R, Trad C, et al. Autoimmune-mediated congenital heart block. Best Pract Res Clin Obstet Gynaecol. 2020;64:41-51. doi:10.1016/j.bpobgyn.2019.09.001
  2. Sterne JAC, Hernán MA, Reeves BC et al. ROBINS-I: a tool for assessing risk of bias in non-randomized studies of interventions. BMJ 2016;355; i4919; doi: 10.1136/bmj.i4919.