Antiphospholipid Syndrome-Associated Crescendo Stroke Events Treated with Rituximab (P4.351)
Discussion APS is an autoimmune condition associated with persistent antiphospholipid antibodies, characterised by thrombosis and pregnancy morbidity .Regarding APS and stroke the optimal antithrombotic agent, intensity of anticoagulation, and duration of treatment remains controversial. Analysis of the APASS subgroup in the WARS study found aspirin and warfarin to be equally effective agents for secondary stroke prevention . The majority of panel members at the International Congress on Antiphospholipid Antibodies recommended warfarin or combination aspirin and warfarin for patients with definite APS and arterial thrombosis . Our patient did not respond to this treatment. B-cells are implicated in the pathogenesis of APS . Rituximab has been used successfully in several case reports of APS and in a Phase II pilot study . Following rituximab infusion this patient had no further thrombotic events. This case adds to emerging experience with rituximab as therapy in refractory APS cases. References 1. Erkan D, Aquiar CL, Andrade D, et al. 14th International Congress on Antiphospholipid Antibodies: task force report on antiphospholipid syndrome treatment trends. Autoimmun Rev 2014 Jun 2. Panichpisal K, Rozner E, Levine SR. The management of stroke in antiphospholipid syndrome. Curr Rheumatol Rep. 2012 FebDisclosure: Dr. O' Connor has nothing to disclose. Dr. Murphy has nothing to disclose. Dr. Cronin has nothing to disclose.