Background/Purpose: Antiphospholipid antibodies in SLE may be changed by treatment, but past studies have been conflicting. We examined the impact of starting or stopping two treatments (hydroxychlorquine and prednisone) on levels of antiphospholipid antibodies.

Methods: 943 SLE patients, who had at least 10 quarterly visits for testing for each anticardiolipin isotype (IgG, IgM and IgA) and dRVVT (lupus anticoagulant; LA), were included in the study. Treatment was recorded at every visit. Visits during which a patient was treated were compared to visits when the same patient was not treated with respect to levels of each antibody using conditional logistic regression.

Results: Hydroxychloroquine treatment reduced the levels of all antibodies, except for IgA aCL (Table 1).

Table 1 – Hydroxychloroquine Reduces All Antiphospholipid Anitbodies EXCEPT for aCL IgA.

¹ In each cell, individuals are informative if they have at least one visit with antiphospholipid positivity, at least one visit without antiphospholipid antibody, at least one visit with when treated with HCQ, and at least one visit when not treated with HCQ.

Prednisone reduced aCL IgG and aCL IgA, but not aCL IgM or dRVVT (seconds prolongation) (Table 2).

Table 2 – Prednisone Reduces aCL IgG and IgA but not lupus anticoagulant (by dRVVT).

Conclusion: Hydroxychloroquine use was associated with reduced lupus anticoagulant (by seconds of prolongation) and reduced titers for most of the isotypes of anticardiolipin, except for IgA. Prednisone did not reduce the seconds of dRVVT prolongation. Anticardiolipin IgA seemed the most resistant to therapy. These data will help clinicians pick prophylactic therapy, which needs to be based on the antiphospholipid subtype.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hydroxychloroquine-and-prednisone-have-different-effects-on-antiphospholipid-antibodies-in-sle-with-hydroxychloroquine-not-reducing-iga-anticardiolipin/