Comparative trial of prednisone plus aspirin versus aspirin alone in the treatment of anticardiolipin antibody-positive obstetric patients

Management of the obstetric antiphospholipid syndrome

“…Live-birth rates were 75% for both treatment groups in the study by Cowchock et al (48) and 100% in that by Silver et al (49). Laskin et al (29) reported live births in 60% of treated pregnancies and in 52% of pregnancies in which placebo was given.…”

“…In those women whose pregnancy and clinical histories put them in the second category (those with recurrent early fetal loss or at least 1 fetal loss, without SLE or previous thrombosis), 3 observational studies evaluated the outcome in women treated with aspirin alone (44), those who received a combination of heparin and aspirin (45), and those who declined pharmacologic treatment and received standard care (46). In 9 prospective studies (12,(29)(30)(31)(32)(47)(48)(49)(50), 2 treatment strategies were compared. All but 2 of these studies (47,50) were randomized studies.…”

“…All but 2 of these studies (47,50) were randomized studies. The treatments included placebo (12,29,32), aspirin alone (12,(30)(31)(32)47,49), aspirin plus prednisone (29,48,49), and heparin plus aspirin (30,31,47,48,50) (Table 3). Evaluation of pregnancies started with a positive pregnancy test (12,29,32,44,47,48,50) or the presence of fetal heart activity (30,31,45,46,49).…”

“…Most women in these studies met the criteria for obstetric APS (14), because they had at least 3 consecutive miscarriages (12,(30)(31)(32)(45)(46)(47)50), at least 2 unexplained pregnancy losses before 12 weeks of gestation or at least 1 pregnancy loss after 12 weeks (44,48,49), or at (47,50). Three studies (47,48,50) emphasized exclusion of women with low aCL levels, and another (49) emphasized inclusion of women with low aCL levels.…”

“…Three randomized studies included a regimen of prednisone and aspirin (29,48,49). The pregnancy outcome of women receiving this treatment was compared with that of women receiving a combination of heparin and aspirin (48), aspirin alone (49), or placebo (29).…”