How plaquenil may help prevent heart damage in newborns
Having lupus adds a lot of “what-ifs” to a pregnancy—especially for women with lupus or Sjogren’s syndrome who also have antibodies to SSA/Ro and/or SSB/La proteins.
According to Jill P. Buyon, M.D., professor of medicine and director of the Division of Rheumatology at New York University School of Medicine and director of the NYU Lupus Center, women with these antibodies face a 2 percent chance of having a child with neonatal lupus who develops a life-threatening heart condition known as “congenital heart block,” or CHB. The heart block can be first-, second-, or third-degree; third-degree (also called “complete”) is the most common form, and it is not reversible.
“In congenital heart block, the baby’s heart beats abnormally slowly,” Buyon explains. “Almost all of the affected children require permanent pacemakers before the age of 20, and some die before birth or shortly thereafter.”
Women who have had one child with CHB have a nearly tenfold higher risk (approximately 18 percent) of having another child with the same heart condition. Even close monitoring during pregnancy cannot reverse complete heart block once it occurs, so treatments aimed at prevention are critical.
Buyon and her colleague Peter Izmirly, M.D., looked at 20 years of accumulated data in the national Research Registry for Neonatal Lupus and found something interesting: “When we restricted the analysis of the pregnancies complicated by heart block to lupus patients, we saw less use of Plaquenil in those whose babies developed heart block,” Buyon says. Plaquenil (hydroxychloroquine) is a drug taken by nearly everyone with lupus—even in pregnancy, as it has been proved to be safe for the fetus. But might it have a protective effect against heart block, as well?
Buyon and Izmirly designed a two-stage research study that they named “preventive approach to congenital heart block with hydroxychloroquine (PATCH).”
“The plan for Stage One was to enroll 19 pregnant women who had a previous child with heart block, and if three of them had infants that developed heart block, then the study would be deemed not successful,” Buyon explains.
The researchers were encouraged when only one case of heart block occurred. For the study’s second stage, they will track an additional 35 pregnant women who have had a previous child with heart block.
“We think hydroxychloroquine is very important to maintain during pregnancy to avoid a potential flare. But I think there are benefits both to the mother and to the baby, in this case,” Buyon says.