Several case reports have emerged in the last few years citing rituximab as a treatment for resistant APS. Firstly, it has been used by various teams to reduce aCL antibodies and consequently improve platelet count in difficult cases of thrombocytopenia resistant to conventional therapies [52–54]. Some reports suggest only a partial effect of rituximab on
platelet count [55], whereas others have shown a reduction in IgM aCL co-existent with clinical improvement of refractory autoimmune haemolytic anaemia [56].
Rituximab has also been used in those with recurring thromboses despite high-dose warfarin, immunosuppressants, plasma exchange or IVIgs. Several authors have observed a dramatic resolution in symptoms ranging from 10 to 36 months’ duration and there is now hope for a new potential therapy in CAPS with proven efficacy in CAPS and thrombocytopenia, after four infusions [46, 52, 54].
CONCLUSION
It is 25 years since APS was first fully described by Graham Hughes. During the last three decades huge advances have been made in detailing the clinical manifestations of this autoimmune disease and it is now recognized as being more systemic than SLE. Treatment strategies for the more common thrombotic manifestations are starting to be tested in randomized controlled trials, but therapies for the less recognized symptoms are still awaiting proper evaluation. As our knowledge increases around the exact mechanisms of aPL-induced thrombosis, pregnancy morbidity and cerebral symptoms, new therapies will be developed, such as rituximab, and existing therapies, such as heparin and IVIg, may be modified.
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