Managing Antiphospholipid Syndrome in Children and Adolescents: Current and Future Prospects

Author(s)

Islabao, Aline Garcia ^{[1, 2]} ; Trindade, Vitor Cavalcanti ^[3] ; da Mota, Licia Maria Henrique ^{[2, 4]} ; Andrade, Danieli Castro Oliveira ^[5] ; Silva, Clovis Artur ^{[3, 5]}

Affiliation

^[1] Hosp Crianca Brasilia Jose Alencar, Pediat Rheumatol Unit, Brasilia, DF - Brazil

^[2] Univ Brasilia, Programa Posgrad Ciencias Med, Fac Med, Brasilia, DF - Brazil

^[3] Univ Sao Paulo, Children & Adolescent Inst, Hosp Clin HCFMUSP, Fac Med, Av Dr Eneas Carvalho Aguiar, 647 Cerqueira Cesar, BR-05403000 Sao Paulo, SP - Brazil

^[4] Univ Brasilia, Hosp Univ Brasilia, Rheumatol Unit, Brasilia, DF - Brazil

^[5] Univ Sao Paulo, Hosp Clin HCFMUSP, Rheumatol Div, Fac Med, Sao Paulo, SP - Brazil

• Document type: Journal article
• Source: PEDIATRIC DRUGS; v. 24, n. 1 DEC 2021.
• Web of Science Citations: 0

Abstract

Pediatric antiphospholipid syndrome (APS) is a rare acquired multisystem autoimmune thromboinflammatory condition characterized by thrombotic and non-thrombotic clinical manifestations. APS in children and adolescents typically presents with large-vessel thrombosis, thrombotic microangiopathy, and, rarely, obstetric morbidity. Non-thrombotic clinical manifestations are frequently seen in pediatric APS and may be present even before the vascular thrombotic events occur. We review insights into the pathogenesis of APS and discuss potential targets for therapy. The identification of multiple immunologic abnormalities in patients with APS reveals molecular targets for current or future treatment. Management strategies, especially for APS in adolescents, require screening for additional prothrombotic risk factors and consideration of counseling regarding contraceptive strategies, lifestyle recommendations, treatment adherence, and mental health issues associated with this autoimmune thrombophilia. The main goal of therapy in pediatric APS is the prevention of thrombosis. The management of acute thrombosis events in children and adolescents is the same as for primary APS, which involves isolated occurrences, and secondary APS, which is seen in association with another autoimmune disease, e.g., systemic lupus erythematosus. A pediatric hematologist should be consulted so other differential thrombophilic conditions can be eliminated. Therapy includes unfractionated heparin or low-molecular-weight heparin followed by vitamin K antagonists. Treatment of catastrophic APS involves triple therapy (anticoagulation, intravenous corticosteroid pulse therapy, and plasma exchange) and may include intravenous immunoglobulin for children and adolescents with this condition. New drugs such as eculizumab and sirolimus seem to be promising drugs for APS. (AU)

• FAPESP's process: 15/03756-4 - Assessment of relevance of blood levels of drugs in the monitoring rheumatic autoimmune diseases: safety, effectiveness and adherence to therapy
• Grantee: Eloisa Silva Dutra de Oliveira Bonfá
• Support Opportunities: Research Projects - Thematic Grants