Case Reports
29 July 2025

The use of tumor necrosis factor inhibitors during high-risk pregnancies in antiphospholipid syndrome: a clinical report of a patient with concomitant Takayasu arteritis and case-based review

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
59
Views
13
Downloads

Authors

In the field of obstetric antiphospholipid syndrome (APS), studies in mouse models and case reports support the potential benefit of tumor necrosis factor-α inhibitors (TNF-i) in preventing pregnancy loss associated with APS. We present the case of a 36-year-old woman with a diagnosis of Takayasu arteritis who suffered from antiphospholipid antibody (aPL)-related thrombotic microangiopathy/probable catastrophic APS during her first pregnancy and who had a subsequent successful pregnancy while on treatment with certolizumab pegol (CZP), heparin, and low-dose aspirin. The report is followed by the literature review of published cases of APS or aPL-positive pregnancies treated with CZP or other TNF-i. A total of 20 pregnancies, including the one here presented, were reported in high-risk APS patients exposed to TNF-i, showing a favorable outcome in most pregnancies (80% live births, 69% absence of adverse pregnancy outcomes). Despite the limited available evidence, TNF-i could represent a promising option for high-risk patients in obstetric APS.

Altmetrics

Downloads

Download data is not yet available.

Citations

Mason JC. Takayasu arteritis—advances in diagnosis and management. Nat Rev Rheumatol 2010; 6: 406-15. DOI: https://doi.org/10.1038/nrrheum.2010.82
Abisror N, Mekinian A, Hachulla E, Lambert M, Morel N, Chapelon C, et al. Analysis of risk factors for complications and adverse obstetrical outcomes in women with Takayasu arteritis: a French retrospective study and literature review. Clin Rheumatol 2020; 39: 2707-13. DOI: https://doi.org/10.1007/s10067-020-05024-4
Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4: 295-306. DOI: https://doi.org/10.1111/j.1538-7836.2006.01753.x
Barbhaiya M, Zuily S, Naden R, Hendry A, Manneville F, Amigo MC, et al. 2023 ACR/EULAR antiphospholipid syndrome classification criteria. Ann Rheum Dis 2023; 82: 1258-70. DOI: https://doi.org/10.1136/ard-2023-224609
Andreoli L, Regola F, Caproli A, Crisafulli F, Fredi M, Lazzaroni MG, et al. Pregnancy in antiphospholipid syndrome: what should a rheumatologist know? Rheumatology 2024; 63: SI86-95. DOI: https://doi.org/10.1093/rheumatology/kead537
Lee HJ, Hwang JP, Kim HS. Takayasu arteritis and antiphospholipid antibody syndrome in an elderly woman. Korean J Intern Med 2015; 30: 934-7. DOI: https://doi.org/10.3904/kjim.2015.30.6.934
Morović-Vergles J. Takayasu’s arteritis associated with antiphospholipid antibodies. Rheumatol Int 2006; 26: 773-4. DOI: https://doi.org/10.1007/s00296-005-0065-4
Santiago MB, Paz O. Rare association of antiphospholipid syndrome and Takayasu arteritis. Clin Rheumatol 2007; 26: 821-2. DOI: https://doi.org/10.1007/s10067-006-0277-3
Jovicic Z, Dragasevic S, Petkovic A, Plesinac S, Sokic Milutinovic A, Stojanovic M. Successful pregnancies in a patient with Takayasu arteritis and antiphospholipid syndrome, maintained on infliximab corticosteroid-free regimen: case-based review. Rheumatol Int 2024; 44: 1359-67. DOI: https://doi.org/10.1007/s00296-023-05440-0
Hellmich B, Agueda A, Monti S, Buttgereit F, De Boysson H, Brouwer E, et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2020; 79: 19-30. DOI: https://doi.org/10.1136/annrheumdis-2019-215672
Salmon JE, Guerra M, Kim M, Ware Branch D. 1201 IMPACT study: preliminary results of a trial with a biologic to prevent preeclampsia in women with antiphospholipid syndrome. Lupus Nephritis 2022; 9: A84-A85. DOI: https://doi.org/10.1136/lupus-2022-lupus21century.83
Erkan D. Expert perspective: management of microvascular and catastrophic antiphospholipid syndrome. Arthritis Rheumatol 2021; 73: 1780-90. DOI: https://doi.org/10.1002/art.41891
Legault K, Schunemann H, Hillis C, Yeung C, Akl EA, Carrier M, et al. McMaster RARE-bestpractices clinical practice guideline on diagnosis and management of the catastrophic antiphospholipid syndrome. J Thromb Haemost 2018; 16: 1656-64. DOI: https://doi.org/10.1111/jth.14192
Novikov PI, Smitienko IO, Sokolova MV, Alibaz-Oner F, Kaymaz-Tahra S, Direskeneli H, et al. Certolizumab pegol in the treatment of Takayasu arteritis. Rheumatology 2018; 57: 2101-5. DOI: https://doi.org/10.1093/rheumatology/key197
Centre for Musculoskeletal Research. PO7:85 | The first reported successful pregnancy with certolizumab in an obstetric antiphospholipid syndrome (APS) patient with multiple miscarriages.
Alijotas-Reig J, Esteve-Valverde E, Llurba E, Gris JM. Treatment of refractory poor aPL-related obstetric outcomes with TNF-alpha blockers: maternal-fetal outcomes in a series of 18 cases. Semin Arthritis Rheum 2019; 49: 314-8. DOI: https://doi.org/10.1016/j.semarthrit.2019.02.006
Genest G, Spitzer KA, Laskin CA. Maternal and fetal outcomes in a cohort of patients exposed to tumor necrosis factor inhibitors throughout pregnancy. J Rheumatol 2018; 45: 1109-15. DOI: https://doi.org/10.3899/jrheum.171152
Asherson RA, Cervera R, De Groot PG, Erkan D, Boffa MC, Piette JC, et al. Catastrophic antiphospholipid syndrome: international consensus statement on classification criteria and treatment guidelines. Lupus 2003; 12: 530-4. DOI: https://doi.org/10.1191/0961203303lu394oa
Abou‐Ismail MY, Kapoor S, Citla Sridhar D, Nayak L, Ahuja S. Thrombotic microangiopathies: an illustrated review. Res Pract Thromb Haemost 2022; 6: e12708. DOI: https://doi.org/10.1002/rth2.12708
Hanna RM, Henriksen K, Kalantar-Zadeh K, Ferrey A, Burwick R, Jhaveri KD. Thrombotic microangiopathy syndromes—common ground and distinct frontiers. Adv Chronic Kidney Dis 2022; 29: 149-60.e1. DOI: https://doi.org/10.1053/j.ackd.2021.11.006
Schmidt CQ, Schrezenmeier H, Kavanagh D. Complement and the prothrombotic state. Blood 2022; 139: 1954-72. DOI: https://doi.org/10.1182/blood.2020007206
Madenidou AV, Kither H, Dyball S, Bruce IN, Tower C. Added IMPACT: the first successful natural birth using certolizumab in obstetric APS. Thromb Res 2024; 241: 109088. DOI: https://doi.org/10.1016/j.thromres.2024.109088
Branch DW, Kim MY, Guerra MM, Worden J, Laskin CA, DeSancho MT, et al. Certolizumab pegol to prevent adverse pregnancy outcomes in patients with antiphospholipid syndrome and lupus anticoagulant (IMPACT): results of a prospective, single-arm, open-label, phase 2 trial. Ann Rheum Dis 2025; 84: 1011-22. DOI: https://doi.org/10.1016/j.ard.2025.02.012

How to Cite



The use of tumor necrosis factor inhibitors during high-risk pregnancies in antiphospholipid syndrome: a clinical report of a patient with concomitant Takayasu arteritis and case-based review. (2025). Reumatismo. https://doi.org/10.4081/reumatismo.2025.1835