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vol. 55

Treatment with biologics during pregnancy in patients with rheumatic diseases

Frauke Förger

Reumatologia 2017; 55, 2: 57–58
Online publish date: 2017/04/28
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Chronic inflammatory rheumatic diseases frequently affect women of the reproductive age. For these women family planning is an important issue in their life, yet this issue is characterized by a lot of concerns and conflicting information for both patients and doctors. To control disease activity and prevent joint or organ damage, a long-term immunosuppressive therapy is necessary in these patients. However, treatment during pregnancy concerns both, mother and unborn child. A pregnant woman with a chronic inflammatory rheumatic disease will always chose treatment with a pregnancy-compatible drug that shows a convincing safety profile for her and her unborn child. Disease activity and medication (like non-steroidal antirheumatic drugs or prednisolone) can have a negative influence on fertility and pregnancy outcome [1]. On the other hand, pregnancy can influence disease activity in a positive way (e.g. rheumatoid arthritis – RA) or in a negative way (e.g. axial spondyloarthritis – axSpA) [2].
For the management of patients with rheumatic diseases who plan to become pregnant, both, disease activity and therapeutic regimen have to be taken into consideration. In general, pregnancy can be planned in case of a stable inactive disease and in case of pregnancy-compatible drugs. The only biologic drugs that are regarded compatible with pregnancy are TNF inhibitors (TNFi) [3]. Based on the time of TNFi use during pregnancy, different points need to be considered. For the use of TNFi in the first trimester of pregnancy, the question arises whether TNFi increase the risk of miscarriage or malformation. In their systematic literature review the European League against Rheumatism (EULAR) analyzed the outcome of 2492 pregnancies exposed to TNFi [3]. No increased rate of miscarriages or congenital malformations could be found among those TNFi exposed pregnancies [3]. Accordingly, a recent systematic review and meta-analysis could not find an increased risk of miscarriages or malformation comparing TNFi users versus non-users [4]. For the use of TNFi in the second or third trimester of pregnancy, the potential of transplacental passage needs to be looked at. During the second and third trimester, IgG1 molecules are actively transported from the maternal circulation to the fetal circulation via binding to the neonatal Fc receptor on trophoblast cells [5]. The transport is most intense during the third trimester resulting in neonatal IgG1 levels that often...

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