Nuestros investigadores

María José Cuadrado Lozano

Publicaciones científicas más recientes (desde 2010)

Autores: Radin, M. ; Cecchi, I. ; Schreiber, K. ; et al.
ISSN 0049-0172  Vol. 50  Nº 3  2020  págs. 553 - 556
Background: The current treatment to prevent pregnancy morbidity (PM) associated with antiphospholipid antibodies (aPL) is based on the use of low dose aspirin and low molecular weight heparin (henceforth defined as standard of care (SoC) treatment). Despite the SoC, up to 30% of women with aPL continue to have pregnancy complications. The global antiphospholipid syndrome (APS) score (GAPSS) is a tool to quantify the risk for the aPL-related clinical manifestations. In this study, we investigated the individual clinical response to SoC in women with aPL after stratifying them according to their GAPSS. Methods: One-hundred-fourty-three women (352 pregnancies) with aPL ever pregnant treated with SoC therapy were included. The patients GAPSS was then grouped according to the patients' GAPSS into low risk (< 6), medium risk (6-11), and high risk (>= 12). Results: The live birth rate was 70.5% (248 out of the 352 pregnancies), 45 patients (31%) experienced at least one event of PM, defined as early or late. Patients were stratified according to GAPSS values, in order to identify a low risk group (GAPSS <6, n = 72), a medium risk group (GAPSS 6-11, n = 66) and a high risk group (GAPSS >= 12, n = 5). When considering patients who ever experienced any PM while treated with SoC, all patients in the high risk group experienced PM, while patients in the medium group had a significant higher rate of PM when compared to the low risk group [29 (43.9%) patients V.s. 11 (15.3%), respectively; p < 0.001]. When analysing the number of pregnancies in the three groups, patients in the high risk group had significantly lower live birth rates, when compared to the other groups [11 (40.7%) live births vs. 100 (62.1%) and 137 (82.5%), respectively; p < 0.05]. Furthermore, patients with medium risk group also had significantly lower live birth rates, when compared to the lower risk group (p < 0.001). Conclusions: GAPSS might be a valuable tool for to identify patients with a higher likelihood of response to SoC. (C) 2020 Elsevier Inc. All rights reserved.
Autores: Cohen, H., (Autor de correspondencia); Cuadrado Lozano, María José; Erkan, D.; et al.
Revista: LUPUS
ISSN 0961-2033  Vol. 29  Nº 12  2020  págs. 1571 - 1593
Antiphospholipid syndrome (APS), an acquired autoimmune thrombophilia, is characterised by thrombosis and/or pregnancy morbidity in association with persistent antiphospholipid antibodies. The 16th International Congress on Antiphospholipid Antibodies Task Force on APS Treatment Trends reviewed the current status with regard to existing and novel treatment trends for APS, which is the focus of this Task Force report. The report addresses current treatments and developments since the last report, on the use of direct oral anticoagulants in patients with APS, antiplatelet agents, adjunctive therapies (hydroxychloroquine, statins and vitamin D), targeted treatment including rituximab, belimumab, and anti-TNF agents, complement inhibition and drugs based on peptides of beta-2-glycoprotein I. In addition, the report summarises potential new players, including coenzyme Q10, adenosine receptor agonists and adenosine potentiation. In each case, the report provides recommendations for clinicians, based on the current state of the art, and suggests a clinical research agenda. The initiation and development of appropriate clinical studies requires a focus on devising suitable outcome measures, including a disease activity index, an optimal damage index, and a specific quality of life index.
Autores: Caliz Caliz, R., (Autor de correspondencia); Diaz del Campo Fontecha, P.; Galindo Izquierdou, M.; et al.
ISSN 1699-258X  Vol. 16  Nº 2  2020  págs. 71 - 86
Objective: The difficulty in diagnosis and the spectrum of clinical manifestations that can determine the choice of treatment for primary antiphospholipid syndrome (APS) has fostered the development of recommendations by the Spanish Society of Rheumatology (SER), based on the best possible evidence. These recommendations can serve as a reference for rheumatologists and other specialists involved in the management of APS. Methods: A panel of four rheumatologists, a gynaecologist and a haematologist with expertise in APS was created, previously selected by the SER through an open call or based on professional merits. The stages of the work were: identification of the key areas for drafting the document, analysis and synthesis of the scientific evidence (using the Scottish Intercollegiate Guidelines Network [ SIGN] levels of evidence) and formulation of recommendations based on this evidence and formal assessment or reasoned judgement techniques (consensus techniques). Results: 46 recommendations were drawn up, addressing five main areas: diagnosis and evaluation, measurement of primary thromboprophylaxis, treatment for APS or secondary thromboprophylaxis, treatment for obstetric APS and special situations. These recommendations also include the role of novel oral anticoagulants, the problem of recurrences or the key risk factors identified in these subjects. This document reflects the first 21, referring to the areas of: diagnosis, evaluation and treatment of primary APS. The document provides a table of recommendations and treatment algorithms. Conclusions: An update of the SER recommendations on APS is presented. This document corresponds to part I, related to diagnosis, evaluation and treatment. These recommendations are considered tools for decision-making for clinicians, taking into consideration both the decision of the physician experienced in APS and the patient. A part II has also been prepared, which addresses aspects related to obstetric SAF and special situations. Published by Elsevier Espalia, S.L.U.
Autores: Tektonidou, M. G., (Autor de correspondencia); Andreoli, L.; Limper, M. ; et al.
ISSN 0003-4967  Vol. 78  Nº 10  2019  págs. 1296 - 1304
The objective was to develop evidence-based recommendations for the management of antiphospholipid syndrome (APS) in adults. Based on evidence from a systematic literature review and expert opinion, overarching principles and recommendations were formulated and voted. High-risk antiphospholipid antibody (aPL) profile is associated with greater risk for thrombotic and obstetric APS. Risk modification includes screening for and management of cardiovascular and venous thrombosis risk factors, patient education about treatment adherence, and lifestyle counselling. Low-dose aspirin (LDA) is recommended for asymptomatic aPL carriers, patients with systemic lupus erythematosus without prior thrombotic or obstetric APS, and nonpregnant women with a history of obstetric APS only, all with high-risk aPL profiles. Patients with APS and first unprovoked venous thrombosis should receive long-term treatment with vitamin K antagonists (VKA) with a target international normalised ratio (INR) of 2-3. In patients with APS with first arterial thrombosis, treatment with VKA with INR 2-3 or INR 3-4 is recommended, considering the individual's bleeding/thrombosis risk. Rivaroxaban should not be used in patients with APS with triple aPL positivity. For patients with recurrent arterial or venous thrombosis despite adequate treatment, addition of LDA, increase of INR target to 3-4 or switch to low molecular weight heparin may be considered. In women with prior obstetric APS, combination treatment with LDA and prophylactic dosage heparin during pregnancy is recommended. In patients with recurrent pregnancy complications, increase of heparin to therapeutic dose, addition of hydroxychloroquine or addition of low-dose prednisolone in the first trimester may be considered. These recommendations aim to guide treatment in adults with APS. High-quality evidence is limited, indicating a need for more research.
Autores: Radin, M.; Schreiber, K. ; Sciascia, S., (Autor de correspondencia); et al.
ISSN 0340-6245  Vol. 119  Nº 12  2019  págs. 1920 - 1926
Objective This article aims to analyse the rate of antiphospholipid antibodies (aPL) negativisation in patients with antiphospholipid syndrome (APS), and to evaluate potential new clinical manifestations after negativisation and/or aPL fluctuations in a long-term follow-up. Methods Inclusion criteria are (1) any patients with an APS diagnosis according to the current Sydney criteria and (2) patients in whom aPL negativisation occurred. aPL negativisation was defined as repeated aPL measurements on at least two consecutive occasions at least 12 weeks apart, with a follow-up of at least 1 year since aPL first turned negative. Results Out of 259 APS patients, a total of 23 patients (8.9%) met the inclusion criteria for persistent aPL negativisation. Patients were followed-up for 14.4 +/- 8.1 years, experienced aPL negativisation after a mean of 5.3 +/- 3.5 years and were followed-up after experiencing the aPL negativisation for a mean of 7.6 +/- 5.8 years. Seventeen patients (73.9%) presented with thrombotic APS, 2 with pregnancy morbidity (8.7%) and 4 (17.4%) with both. Most of the patients (18; 78.3%) had a single aPL positivity, 5 (21.7%) double, while no triple aPL positivity was observed. At the time of data collection, after aPL negativisation, anticoagulation was stopped in 8 patients with previous thrombotic venous event (8/21, 38%) according to the treating physicians' judgements. None of the patients experienced any recurrent thrombotic event during the follow-up period after their aPL negativisation. Conclusion In our patient cohort consisting of 259 patients with definitive APS, we observed over a mean observation period of > 5 years, that aPL negativisation occurred in approximately 9% of patients. Negativisation occurred most often in patients who were previously found to be positive for only one aPL.
Autores: García de Yébenes Castro, Manuel; Caballeros Lam, Fanny Meylin; Huerta, A.; et al.
ISSN 2047-2404  Vol. 20  Nº Suppl.2  2019  págs. 396 - 396
Autores: Radin, M.; Schreiber, K.; Sciascia, S.; et al.
Revista: LUPUS
ISSN 0961-2033  Vol. 28  Nº Suppl.1  2019  págs. 21 - 22
Autores: Enríquez Merayo, Eugenia; Sciascia, S.; Roccatello, D.; et al.
ISSN 1744-666X  Vol. 14  Nº 11  2018  págs. 877-879
Autores: Schreiber, K.; Radin, M.; Cecchi, I. ; et al.
ISSN 2326-5191  Vol. 70  2018 
Autores: Sciascia, S.; Yazdany, J.; Cuadrado Lozano, María José; et al.
ISSN 2326-5191  Vol. 70  Nº Suppl. 9  2018 
Autores: Lopez-Pedrera, C. ; Cecchi, I.; Barbarroja, N.; et al.
ISSN 2326-5191  Vol. 70  Nº Suppl. 9  2018 
Autores: Perez-Sanchez, C. ; Sanchez, L. P. ; Patino-Trives, A. M.; et al.
ISSN 2326-5191  Vol. 70  Nº Suppl. 9  2018 
Autores: Radin, M. ; Schreiher, K.; Cuadrado Lozano, María José; et al.
ISSN 2326-5191  Vol. 70  Nº Suppl. 9  2018  págs. 1-3