PMID- 33081590
OWN - NLM
STAT- MEDLINE
DCOM- 20210830
LR  - 20210830
IS  - 1477-0962 (Electronic)
IS  - 0961-2033 (Linking)
VI  - 30
IP  - 1
DP  - 2021 Jan
TI  - Prevention of recurrent miscarriage in women with antiphospholipid syndrome: A 
      systematic review and network meta-analysis.
PG  - 70-79
LID - 10.1177/0961203320967097 [doi]
AB  - OBJECTIVES: To compare and rank currently available pharmacological interventions 
      for the prevention of recurrent miscarriage (RM) in women with antiphospholipid 
      syndrome (APS). METHODS: A search was performed using PubMed, Embase, the 
      Cochrane Central Register of Controlled Trials, Web of Science, CNKI, 
      ClinicalTrials.gov, and the UK National Research Register on December 15, 2019. 
      Studies comparing any types of active interventions with placebo/inactive control 
      or another active intervention for the prevention of RM in patients with APS were 
      considered for inclusion. The primary outcomes were efficacy (measured by live 
      birth rate) and acceptability (measured by all-cause discontinuation); secondary 
      outcomes were birthweight, preterm birth, preeclampsia, and intrauterine growth 
      retardation. The protocol of this study was registered with Open Science 
      Framework (DOI: 10.17605/OSF.IO/B9T4E). RESULTS: In total, 54 randomized 
      controlled trials (RCTs) comprising 4,957 participants were included. 
      Low-molecular-weight heparin (LMWH) alone, aspirin plus LMWH or unfractionated 
      heparin (UFH), aspirin plus LMWH plus intravenous immunoglobulin (IVIG), aspirin 
      plus LMWH plus IVIG plus prednisone were found to be effective pharmacological 
      interventions for increasing live birth rate (ORs ranging between 2.88 to 11.24). 
      In terms of acceptability, no significant difference was found between 
      treatments. In terms of adverse perinatal outcomes, aspirin alone was associated 
      with a higher risk of preterm birth than aspirin plus LMWH (OR 3.92, 95% CI 1.16 
      to 16.44) and with lower birthweight than LMWH (SMD -808.76, 95% CI -1596.54 to 
      -5.07). CONCLUSIONS: Our findings support the use of low-dose aspirin plus 
      heparin as the first-line treatment for prevention of RM in women with APS, and 
      support the efficacy of hydroxychloroquine, IVIG, and prednisone when added to 
      current treatment regimens. More large-scale, high-quality RCTs are needed to 
      confirm these findings, and new pharmacological options should be further 
      evaluated.
FAU - Yang, Ziyi
AU  - Yang Z
AUID- ORCID: 0000-0002-4138-5598
AD  - The First Clinical College of Chongqing Medical University, Chongqing, China.
FAU - Shen, Xiangli
AU  - Shen X
AD  - Department of Obstetrics, Chengdu Jinjiang Maternity and Child Health Hospital, 
      Chengdu, China.
FAU - Zhou, Chuqing
AU  - Zhou C
AD  - The First Clinical College of Chongqing Medical University, Chongqing, China.
FAU - Wang, Min
AU  - Wang M
AD  - North Sichuan Medical College, Nanchong, China.
FAU - Liu, Yi
AU  - Liu Y
AD  - Department of Obstetrics, Chengdu Jinjiang Maternity and Child Health Hospital, 
      Chengdu, China.
FAU - Zhou, Lin
AU  - Zhou L
AD  - Department of Obstetrics, Chengdu Jinjiang Maternity and Child Health Hospital, 
      Chengdu, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20201020
PL  - England
TA  - Lupus
JT  - Lupus
JID - 9204265
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Abortion, Habitual/*prevention & control
MH  - Antiphospholipid Syndrome/*drug therapy
MH  - Aspirin/adverse effects/*therapeutic use
MH  - Drug Therapy, Combination
MH  - Female
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Live Birth
MH  - Pregnancy
MH  - Premature Birth/chemically induced
MH  - Randomized Controlled Trials as Topic
OTO - NOTNLM
OT  - Antiphospholipid syndrome
OT  - network meta-analysis
OT  - pregnancy
OT  - recurrent miscarriage
OT  - systematic review
EDAT- 2020/10/22 06:00
MHDA- 2021/08/31 06:00
CRDT- 2020/10/21 05:36
PHST- 2020/10/22 06:00 [pubmed]
PHST- 2021/08/31 06:00 [medline]
PHST- 2020/10/21 05:36 [entrez]
AID - 10.1177/0961203320967097 [doi]
PST - ppublish
SO  - Lupus. 2021 Jan;30(1):70-79. doi: 10.1177/0961203320967097. Epub 2020 Oct 20.