HCQS reduces Preeclampsia in SLE-affected pregnancy, while aspirin has no role, study confirms

Australia: A single-centre retrospective study of lupus-affected pregnancies has concluded that hydroxychloroquine significantly lowers the risk of preeclampsia.

The researchers have also added that there is no association between aspirin and preeclampsia.

The findings of the study are published in the Pregnancy Hypertension.

It is already known that Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease affecting women of childbearing age disproportionately. Preeclampsia occurs in approximately 25 % of SLE-affected pregnancies, which further increases the complications (both maternal and fetal).

Hydroxychloroquine (HCQ) has properties (anti-inflammatory, antioxidant, anti-thrombotic) which impacts the outcomes of pregnancy in such cases. It is recommended in pregnant women with SLE because it reduces the disease flare risk. But its role remains uncertain, and it has conflicting results.

Studies suggest aspirin significantly reduces preterm preeclampsia (high-risk women) and is therefore recommended for prophylaxis due to the pro-angiogenic effect. This effect is theoretical and has no evidence that it significantly reduces risk in this population group.

Considering this, a study was conducted to determine the actual effect of aspirin on preeclampsia risk in women with SLE. The researchers determined the association between hydroxychloroquine, aspirin and preeclampsia using adjusted logistic regression models.

The summary points of the study are:

•  Hydroxychloroquine significantly lowered the risk of preeclampsia in 95 pregnancies with an adjusted OR of 0.16.
• There was no association between aspirin and preeclampsia with an adjusted OR of 1.34.
•   Preeclampsia affected 17 pregnancies constituting 11.8 % and 25 % in the HCQ exposed and the HCQ unexposed group with OR of 0.40 with a 95% Confidence Interval.
• There was no record of the severity of preeclampsia.

The researchers commented in the short communication that SLE is related to higher preeclampsia rates. Aspirin and HCQ are recommended in such cases, but there is a lack of studies explaining these outcomes in the Australian cohort.

The study has highlighted that HCQ lower preeclampsia risk while there is no association between aspirin and preeclampsia.

Further reading:

Short communication. Preeclampsia in women with lupus – influence of aspirin and hydroxychloroquine on pregnancy outcome. Jessica Phillips et al.