Ab0551 intravenous Immunoglobulin in Pregnant Women With Severe Active Lupus: A Case Series

Abstract

BackgroundEvidence on the management of pregnant patients with lupus activity is limited. The choice of pharmacological treatment is decisive for an adequate outcome.ObjectivesTo show the experience of management with intravenous immunoglobulin (IVIG) in pregnant patients with severe active lupus.MethodsCase series from January 2020 to November 2022 of pregnant patients being managed with IVIG in a hospital in Bogotá, Colombia.ResultsOut a total of 33 pregnant patients evaluated during the period, three cases of the use of IVIG in pregnant patients with severe lupus were found (Figure 1). The main involvement of lupus was renal (increased proteinuria), hematological (thrombocytopenia) and vascular [Intrauterine growth restriction (IUGR) and threatened abortion]. Average age was 30.3 years. One of the patients was diagnosed de novo with the disease during pregnancy, IVIG was given due to thrombocytopenia with resolution, but she presented fetal loss due to sepsis, in addition she had maternal vascular complications due to polyautoimmunity with antiphospholipid syndrome. The other two patients underwent IVIG at 24 weeks, one of them reached week 30 without considering new immunoglobulin applications, in the second case due to persistent proteinuria she received two additional cycles reaching 33 weeks of gestation. In both cases, a cesarean section was performed by IUGR at 30 and 33 weeks respectively. There were no complications associated with the newborns, with good response to proteinuria and resolution of cytopenias (See Table 1). There were no adverse drug events reported in any case.ConclusionIVIG can be a useful medication for the treatment of severe active lupus in pregnant patients, mainly in those with renal and hematological involvement. It is important to highlight IVIG has high safety and few side effects, on the mothers with lupus and their offspring’s.Table 1.Characteristics of PatientsCharacteristicsCase 1Case 2Case 3Patients Age, years323425Pregnancy weeks at the start IVIG724,124Body weight, kg656866Number of prior miscarriage000Serology ANAS Patern Ro/La SM/RNP APS profile1/640homogeneousNegativeNegativeDouble positive1/1280homogeneous129/130 (+)NegativeNegative1/320speckledNegativeNegativeNegativeIndication IVIGSevere active lupus ThrombocytopeniaSevere active lupus NephritisSevere active lupus NephritisPosology IVIG65 g (1g/kg), Single dose136 g (2 g/kg), Single dose132 g (2 g/kg), monthly (3 doses)Days administration IVIG254Side effects with IVIGNoneNoneNonePlatelets (Before IVIG)2,100112,000153,000Proteinuria, g/24h (Before IVIG)0.1313.224.7OutcomesPlaquettes250,000207,000388,000Proteinuria, g/24h-9 (2 week after IVIG)10.6 (1 week after last IVIG)Gestational age at miscarriage/delivery, weeks7, Septic Miscarriage30, Cesarean for IUGR33, Cesarean for IUGRPregnancy complicationsStroke, Carotid dissectionNo, Healthy premature NewbornNo, Healthy premature NewbornBreastfeeding-Yes, until 3rd month>3 monthsANA: Antinuclear antibodies, APS: antiphospholipid antibody syndrome, IUGR: Intrauterine growth restriction, IVIG: Intravenous Immunoglobulin,Figure 1.Patients’ backgroundsREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.