Raised serious infection risk with high-dose steroids in pregnancy
medwireNews: Treatment with high-dose steroids during pregnancy is associated with an elevated risk for serious infections among women with autoimmune inflammatory disorders, finds an analysis published in The BMJ.
However, the absolute risk was small with low doses, say the researchers who suggest that “low steroid doses with appropriate monitoring may provide a favorable risk-benefit balance for the management of acute flares” in this patient population.
Furthermore, overall there was no significant difference in serious infection risk between pregnant users of three different immunosuppressive drug classes, namely, steroids, non-biologics, and tumor necrosis factor (TNF) inhibitors.
From the US Medicaid and Optum Clinformatics databases, the team identified 4961 pregnant women who received immunosuppressive therapy for rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, psoriatic arthritis, or inflammatory bowel disease over a 14-year period.
A total of 71 (0.2%) women experienced a serious infection, defined as a bacterial or opportunistic infection requiring hospitalization.
While the risk was comparable regardless of whether patients took steroids, non-biologics, or anti-TNF agents, the dose–response analysis showed a significant association between a higher average daily dose of steroids and increased risk for serious infection, rising by 0.019 per unit increase in mean daily prednisone equivalent dose.
The absolute predicted risk ranged between 0.014 and 0.017 for average daily doses lower than 10 mg, report Rishi Desai (Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA) and team.
They therefore comment: “Use of low dose steroids seems relatively safe for serious infections in pregnancy; however, women should be closely monitored for serious infections if high dose steroids are used for managing otherwise uncontrolled disease activity.”
Desai et al also point out that “selection of an appropriate course of immunosuppressive treatment for managing active autoimmune conditions in pregnancy is a complex task that requires consideration of maternal and fetal safety for multiple outcomes, not only serious infections.”
Factors such as the teratogenic potential of the agent also need to be taken into account, they say.
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