TNF inhibitor discontinuation during pregnancy associated with increased flare risk
medwireNews: Women with inflammatory arthritis who discontinue tumor necrosis factor (TNF) inhibitor therapy during pregnancy may be at increased risk for flare, researchers report.
“There has been some debate concerning [TNF inhibitor] use for rheumatologic conditions during pregnancy” due to limited safety data, and these drugs “are frequently discontinued during the first trimester,” say Geneviève Genest, from Montreal General Hospital, Québec, Canada, and study co-authors.
“The ability to continue [TNF inhibitor] during pregnancy has obvious maternal benefits, and reducing maternal disease activity and flare risk may benefit pregnancy and fetal outcomes,” they add.
The team reviewed medical records from 40 women with inflammatory arthritis – including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis – who were undergoing treatment with TNF inhibitors at the time of conception. The majority (46.0%) of patients were receiving etanercept, followed by certolizumab pegol (23.0%), adalimumab (15.4%), infliximab (7.7%), and golimumab (7.7%).
In all, 11 women with 14 pregnancies elected to stop taking TNF inhibitors upon finding out they were pregnant, and disease flares occurred during 35.7% of these pregnancies. This flare rate was significantly higher than that for the 29 women with 32 pregnancies who continued TNF inhibitor treatment throughout pregnancy, at 9.4%.
Similarly, rates of postpartum flare were significantly higher among women who discontinued TNF inhibitors compared with those who did not, at 66.0% versus 18.7%.
“We did not find that [TNF inhibitor] use throughout pregnancy posed any specific obstetric or fetal risk in this small cohort,” write Genest et al in The Journal of Rheumatology. Average infant birth weight was comparable in the two groups; congenital abnormalities were reported in one infant in the discontinuation group and none in the continuation group.
“Although our cohort is too small to comment on the relationship between in utero [TNF inhibitor] exposure and congenital anomalies, our data are reassuring,” say the researchers.
And they conclude: “In a patient with chronic inflammatory disease with pre- or periconceptual indications for TNF inhibition, we believe that the maternal benefits of continuing [TNF inhibitors] throughout pregnancy outweigh the remote possibility of adverse pregnancy or fetal outcomes.”
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