Clinical immunology
The influence of immunosuppressive therapy on the antiphospholipid antibodies level in active systemic lupus erythematosus patients – nine months study

Introduction: The influence of induction therapy (corticosteroids, immunosuppressive agents) used in active phase systemic lupus erythematosus (SLE) patients (pts) on the antiphospholipid antibodies (aPL) remains not fully explained.

Objective: Therefore, the aim of the study was the assessment of induction therapy effects on the level of the aPLs in active SLE pts.

Material and Methods: Sixty eight consecutive (56 F, 12 M), active SLE pts, mean age 38,3±13,7, entered the study. Patients received high dose steroids and/or cytotoxics: intravenous methylprednisolone pulses + oral steroids in period between pulses (24 pts), intravenous cyclophosphamide pulses + oral steroids in period between pulses (13 pts), intravenous cyclophosphamide, methylprednisolone pulses + oral steroids in period between pulses (14 pts) and oral azathioprine + methylprednisolone pulses
+ oral steroids (17 pts). Activity of SLE was assessed by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). Before intensification of the treatment (0), after 3 (3), 6 (6) and 9 (9) months of the therapy the pts were examined for the presence of the following aPL antibodies: antibodies to cardiolipin (acl) in IgM and IgG class, anti-b2 glycoprotein I (a-B2GPI) in IgM and IgG class. The acl and a-B2GPI antibodies were determined by commercially available ELISA.

Results: The acl in IgM class decreased in first 6 months of the treatment (0 vs. 3 P=0.0004 and
0 vs. 6 P=0.001). The acl in IgG class decreased after 3 months of the treatment (P=0.06). In period between 6 and 9 months of treatment concentrations of acl in IgM class and IgG class increased significantly. Antibodies a-b2 GPI in IgM and IgG class and SLEDAI-2K significantly decreased during the whole period of treatment (9 months).
In conclusion, the induction immunosuppressive therapy used in active SLE pts significantly decreased the level of the antiphospholipid antibodies particularly in early period of treatment.