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  • 1
    In: Arthritis Care & Research, Wiley, Vol. 74, No. 2 ( 2022-02), p. 324-335
    Abstract: To describe the baseline characteristics of patients with positivity for antiphospholipid antibodies (aPLs) who were enrolled in an international registry, the Antiphospholipid Syndrome (APS) Alliance for Clinical Trials and International Networking (APS ACTION) clinical database and repository, overall and by clinical and laboratory subtypes. Methods The APS ACTION registry includes adults who persistently had positivity for aPLs. We evaluated baseline sociodemographic and aPL‐related (APS classification criteria and “non‐criteria”) characteristics of patients overall and in subgroups (aPL‐positive without APS, APS overall, thrombotic APS only, obstetric APS only, and both thrombotic APS/obstetric APS). We assessed baseline characteristics of patients tested for the presence of three aPLs (lupus anticoagulant [LAC] test, anticardiolipin antibody [aCL] , and anti–β 2 ‐glycoprotein I [anti‐β 2 GPI]) antibodies by aPL profiles (LAC only, single, double, and triple aPL positivity). Results The 804 aPL‐positive patients assessed in the present study had a mean age of 45 ± 13 years, were 74% female, and 68% White; additionally, 36% had other systemic autoimmune diseases. Of these 804 aPL‐positive patients, 80% were classified as having APS (with 55% having thrombotic APS, 9% obstetric APS, and 15% thrombotic APS/obstetric APS). In the overall cohort, 71% had vascular thrombosis, 50% with a history of pregnancy had obstetric morbidity, and 56% had experienced at least one non‐criteria manifestation. Among those with three aPLs tested (n = 660), 42% were triple aPL–positive. While single–, double–, and triple aPL–positive subgroups had similar frequencies of vascular, obstetric, and non‐criteria events, these events were lowest in the single aPL subgroup, which consisted of aCLs or anti‐β 2 GPI only. Conclusion Our study demonstrates the heterogeneity of aPL‐related clinical manifestations and laboratory profiles in a multicenter international cohort. Within single aPL positivity, LAC may be a major contributor to clinical events. Future prospective analyses, using standardized core laboratory aPL tests, will help clarify aPL risk profiles and improve risk stratification.
    Type of Medium: Online Resource
    ISSN: 2151-464X , 2151-4658
    URL: Issue
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    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2016713-1
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  • 2
    In: Arthritis & Rheumatology, Wiley, Vol. 72, No. 12 ( 2020-12), p. 1990-1997
    Abstract: To report the clinical experience with anakinra in preventing mechanical ventilation in patients with coronavirus disease 2019 (COVID‐19), symptoms of cytokine storm syndrome, and acute hypoxemic respiratory failure. Methods To be included in this retrospective case series, patients must have had severe acute respiratory syndrome coronavirus 2 (SARS–CoV‐2), fever, ferritin levels 〉 1,000 ng/ml with 1 additional laboratory marker of hyperinflammation, and acute hypoxemic respiratory failure. Acute hypoxemic respiratory failure was defined as requiring 15 liters of supplemental oxygen via a nonrebreather mask combined with 6‐liter nasal cannula or use of ≥95% oxygen by high‐flow nasal cannula. We excluded patients in whom there was suspicion of bacterial infection or who were receiving immunosuppressants. Subcutaneous anakinra was initiated at 100 mg every 6 hours and gradually tapered off completely. The primary outcome was the prevention of mechanical ventilation. Results Of the 14 patients who met the criteria, 11 patients received anakinra for a maximum of 19 days. Seven of the patients who started anakinra treatment ≤36 hours after onset of acute hypoxemic respiratory failure did not require mechanical ventilation, and all were discharged home. Four patients who started anakinra ≥4 days after onset of acute hypoxemic respiratory failure required mechanical ventilation. Of those, 3 patients were extubated (2 discharged home and 1 remained hospitalized), and 1 died. All 3 patients who met the criteria but did not receive anakinra required mechanical ventilation. Two patients were extubated (1 discharged home and 1 remained hospitalized), and 1 remained on mechanical ventilation. Conclusion Our data suggest that anakinra could be beneficial in treating COVID‐19 patients with evidence of cytokine storm syndrome when initiated early after onset of acute hypoxemic respiratory failure. Our patient selection and treatment approach should be considered for investigation in a clinical trial to determine the safety and efficacy of anakinra in treating patients with COVID‐19 and symptoms of cytokine storm syndrome.
    Type of Medium: Online Resource
    ISSN: 2326-5191 , 2326-5205
    URL: Issue
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    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2754614-7
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  • 3
    Online Resource
    Online Resource
    Elsevier BV ; 2022
    In:  Rheumatic Disease Clinics of North America Vol. 48, No. 2 ( 2022-05), p. 455-466
    In: Rheumatic Disease Clinics of North America, Elsevier BV, Vol. 48, No. 2 ( 2022-05), p. 455-466
    Type of Medium: Online Resource
    ISSN: 0889-857X
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
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  • 4
    Online Resource
    Online Resource
    Elsevier BV ; 2021
    In:  Medical Clinics of North America Vol. 105, No. 2 ( 2021-03), p. 273-284
    In: Medical Clinics of North America, Elsevier BV, Vol. 105, No. 2 ( 2021-03), p. 273-284
    Type of Medium: Online Resource
    ISSN: 0025-7125
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
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