#2-21E. Pioneering Prevention: FcRn Blockade for Recurrent Cardiac Neonatal Lupus (ARD, 2025)

How do we manage pregnant patients at the highest risk for recurrent cardiac neonatal lupus (cardiac-NL), which carries high morbidity and mortality? This proof-of-concept study investigated the feasibility of using the FcRn inhibitor rozanolixizumab prophylactically in a 34-year-old SLE patient with three prior NL pregnancies, two complicated by severe cardiac-NL, despite prior conventional therapy. Weekly administration from gestational weeks 14 to 28 successfully reduced maternal anti-SSA/Ro autoantibodies and total IgG levels by approximately 65%1 The patient delivered a healthy, term neonate without cardiac-NL. The crucial finding is the successful prevention of recurrent cardiac-NL, marking the first time an FcRn blocking agent has been used for this indication during human pregnancy. However, clinicians must remember that this was an investigator-initiated single compassionate use case (n=1), necessitating caution when generalizing results. Nonetheless, this report provides essential proof-of-concept data, suggesting a new mechanism-based strategy for managing high-risk anti-SSA/Ro positive pregnancies and supporting the launch of a definitive multicenter trial.

Citation: Carlucci, P. M., et al. Blocking the neonatal Fc receptor as a novel approach to prevent cardiac neonatal lupus: a proof-of-concept study. Annals of the Rheumatic Diseases. 2025. DOI: 10.1016/j.ard.2025.09.011

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.