Implantation Failure/ Reccurent miscarriages- TreatmentPOSTER 5Adalimumab for recurrent miscarriages and implantation failure

Recurrent miscarriages and implantation failures are a frequent and still unresolved clinical situation, without any recommended therapies. In euploid implantation, the impact of dys-immune reaction such as allograft rejection could raise the use of immunomodulatory therapies. TNFa antagonists were recently reported in small case series and here we present a multicenter retrospective cohort study. Patients referred to our center for unexplained miscarriages and or implantation failure and which were refractory to previous various immunomodulatory therapies (HBPM, steroids, hydroxychloroquine) received adalimumab at 40 mg every 2 weeks a month before implantation and until 9 weeks of gestation. The primary objective was the number of pregnancies with alive baby and the safety was the second objective. A total of 42 patients with implantation failure and /or recurrent miscarriage (previous number of failures 9 [4-19], received adalimumab alone or associated with other immunomodulatory therapies. Among them, 27 were pregnant and were analyzed for the efficacy of adalimumab. Among these 27 patients, 16 women (59%) experienced a pregnancy with alive baby and 11 (41%) experienced recurrent miscarriages. The number of previous failures was not significantly different between the women with recurrent miscarriages and others (11 [4-19] vs 9 [4-15]. The number of associated immunosuppressive therapies was not significantly different between women with and without recurrent failures: low molecular weight heparin in 1 and 5 cases, steroids in 5 and 12 cases, hydroxychloroquine in 2 and 6 cases, respectively. There was no case with malformation or teratogenicity in both groups and no cases of maternal serious side effect. In a recurrent miscarriages and implantation failures women with particular high rates of failures, adalimumab seems to allow a good rate of alive babies with a good maternal and fetal tolerance.