Other drugs used to treat APS

Steroids (Prednisolone)

Steroids are generally reserved for those patients with very low platelet counts or sometimes for women who experience a high number of early miscarriages.

Hydroxychloroquine

Hydroxychloroquine is particularly effective in helping skin rashes, fatigue, and aches and pains; it has been used to treat autoimmune conditions for many years. Many APS patients are now being prescribed this with positive results, but it can take up to two or three months before the effects of hydroxychloroquine can be felt.

If you are an APS patient who regularly takes hydroxychloroquine (trade names Plaquenil and Quinoric in the UK), please be aware that the Royal College of Ophthalmologists (RCO) recommends that all patients who take hydroxychloroquine for longer than five years should be referred by their GP, or APS specialist, for a yearly test at a hospital eye clinic. 

This is because recent studies have shown that hydroxychloroquine retinopathy is more common than previously reported – around 7 in every 100 patients - especially with long-term use over five years or heavy doses. The risk is much higher in patients who have been taking the drug for 20 years or more: in these patients, between 20-50 out of 100 will develop retinopathy.

The screening will be comprehensive and your pupils will be dilated with eye drops – for the technical information involved, please read the RCO’s guidelines: 

Hydroxychloroquine and Chloroquine Retinopathy Screening Guideline and Recommendations
 

Intravenous Immunoglobulin (IVIG)

Formed by pooling the globulins (antibodies) from a large group of healthy donors, IVIG appears to neutralize a number of harmful antibodies and has been used in a variety of autoimmune diseases with mixed success. IVIG is extremely expensive, and its action is short-lived but it has been effective in some APS patients, particularly those with low platelet counts.

Immunosuppressives

These drugs (most commonly azathioprine and methotrexate) are widely used in autoimmune diseases such as lupus and rheumatoid arthritis. Ideally, any drug which suppresses the harmful antiphospholipid antibodies would have a major role in APS. However, immunosuppressives have proved disappointing in APS patients, though this continues to be a major focus of research.

Vitamin D

It has recently been found that, as with other autoimmune diseases such as multiple sclerosis and lupus, vitamin D deficiency is common amongst APS patients. The exact effect the lack of vitamin D could have on clotting events is still under scrutiny but, as vitamin D is cheap and has many additional advantages, it seems sensible to recommend that patients get their levels checked and take supplements if necessary.