Table 1.

Biologics used in the management of APS patients. .

Medication	Mechanism	Perspective
Eculizumab	Complement 5 inhibitor	For CAPS refractory to standard treatment, CAPS receiving kidney transplantation, acute TMA in patients with aPL-related nephropathy, APS during pregnancy, or pediatric CAPS (2, 33, 34)
Rituximab	Type I anti-CD20 monoclonal antibody	For thrombocytopenia, hemolytic anemia, or other aPL-mediated hematological and microthrombotic manifestations or noncriteria manifestations; an alternative option for CAPS which is refractory to standard treatment, refractory obstetric APS, and pediatric CAPS (2, 33, 35)
Obinutuzumab	Type II anti-CD20 monoclonal antibody (B-cell depletion mainly via DCD)	Alternative option for rituximab in APS (36)
Belimumab	BAFF/Blys inhibitor	Potential treatment for aPL-positive patients, or primary APS with high thrombotic risk (37–39)
Daratumumab	Anti-CD38 monoclonal antibody	Potential treatment for refractory APS (40, 41)
Zanubrutinib	BTK inhibitor	Unclear, evidence still being collected
Anti-TNF-α therapy	Anti-TNF-α monoclonal antibody: adalimumab, certolizumab	In refractory obstetric APS (42)

CAPS, catastrophic antiphospholipid syndrome; TMA, thrombotic microangiopathy; APS, Antiphospholipid syndrome; DCD, direct cell death; BAFF/Blys, B cell activating factor/B-lymphocyte stimulator; BTK, bruton tyrosine kinase.