"Complementing" the PROMISSE Study

The baby-making business is unpredictable in the best of situations (when the female is healthy). Layer upon that a female with lupus or positive antiphosopholipid (aPL) antibodies and all bets are off. So I was really curious to hear Jane Salmon shed some light on what contributes to the pathophysiology of adverse pregnancy outcomes in lupus patients and those with aPL antibodies.

Dr. Salmon essentially demonstrated to us that the alternative complement pathway is an important contributor to adverse outcomes in pregnancy. The PROMISSE Study (Predictors of pRegnancy Outcomes: BioMarker In Antiphospholipid antibody Syndrome and Systemic Lupus Erythematosus) found that in pregnant SLE/aPL patients, increased levels of Bb (alternative complement pathway) and soluble C5b-9 (terminal complex from activation of all complement pathways) were found early in pregnancy and were strongly associated with adverse pregnancy outcomes (a composite of fetal death, neonatal death, preterm delivery < 36 weeks because of preeclampsia or placental insufficiency and/or growth restriction [<5th percentile]).

So what can we do about this? One suggestion made by the authors was to look at blocking complement to prevent bad outcomes in high-risk lupus and aPL patients. While currently there are no medications which can do this, the study does provide a therapeutic target for further study.

In the meantime, we can optimize treatments that can help, including maintenance of antimalarials, consideration of ASA or anticoagulation when necessary, and strive for lupus disease remission or low disease activity prior to conception attempts.

Increased "complements" for pregnant lupus/aPL patients should therefore relate only to their healthy glow.

More reports from ACR 2015