medwireNews: The authors of a systematic review report that DMARD treatment does not seem to have a detrimental impact on fertility in patients with rheumatoid arthritis (RA), but limited evidence means that more research is needed.
Diederik De Cock (KU Leuven, Belgium) and colleagues identified just four published studies meeting their inclusion criteria that investigated the impact of one or more DMARDs on fertility or time-to-pregnancy (TTP) in adult RA patients. In all, the studies included 392 patients, all of whom were women, with the average age ranging from 31.1 to 48.5 years across the studies.
Among the three studies evaluating methotrexate, one found that RA patients who reported no infertility in the past were more likely to have used methotrexate than those reporting infertility, while the second study showed no significant differences in serum anti-Müllerian hormone levels – a marker of ovarian reserve – in RA patients who did and did not take methotrexate for 6 months. The third study found that 42% of 245 RA patients experienced subfertility (TTP ≥1 year), but prior methotrexate use was not significantly associated with prolonged TTP.
De Cock and team say that one study evaluated the association between sulfasalazine and fertility in the preconception phase, finding no significant association between use of the agent and a TTP of more than 1 year.
And one study investigated the impact of biologics, namely etanercept and certolizumab pegol, on fertility. The study showed that continuation of these agents was associated with a significant shortening of the average TTP compared with discontinuing conventional or biologic DMARDs (5.9 vs 11.0 months).
These findings indicate that “DMARD treatment, contrary to general belief, seemed to have no harmful effect on fertility, possibly because it resulted in better controlled disease activity,” say De Cock and colleagues.
However, they caution that their systematic review was limited by the small number of studies included, as well as small patient numbers in the majority of the included studies, and the lack of research investigating fertility in men.
“Furthermore, the quality of the papers is heterogeneous, with limitations by a retrospective design, by the use of self-report questionnaires or by a limited follow-up,” they add.
The team concludes in Seminars in Arthritis and Rheumatism: “This systematic review underlines the gap in knowledge regarding the effect of DMARDs on fertility in women and especially men with RA.”
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Semin Arthritis Rheum 2020; doi:10.1016/j.semarthrit.2020.07.003