Medicine Matters rheumatology

Table 1. Use of antirheumatic drugs during pregnancy. Adapted from Skorpen et al

IV, intravenous; TNFi, tumor necrosis factor inhibitors; bDMARDs, biologic disease-modifying anti-rheumatic drugs; NSAIDs, non-steroidal anti-inflammatory drugs; COX, cyclooxygenase; JAK, Janus kinase.

*Use should be restricted to 1st and 2nd trimesters;†This group includes tocilizumab, abatacept, rituximab, anakinra, secukinumab, ustekinumab, belimumab. The molecular structure of many of these drugs (monoclonal antibodies) suggests that their transplacental passage may be virtually absent until the second trimester due to the “immaturity” of the placenta. In theory, receiving these drugs during the first trimester should not cause any adverse effect on the fetus. Their prescription may be considered if there is no other therapeutic option available to ensure proper disease control; ‡Use may be justified only to treat life-threatening conditions during the 2nd and 3rd trimester.