Background High activity levels of rheumatoid arthritis (RA) may lead to reduced fertility or further deterioration of the disease after pregnancy. Therefore, it is important for patients with RA to become pregnant while they are in remission. On the other hand, RA relapses in approximately half of patients within 1 month after delivery.1 Accordingly, drugs should be selected taking into consideration the overall use before and after pregnancy, and after delivery.
Objectives The objective of the present study is to investigate the efficacy/safety of monotherapy with etanercept (ETN) in patients with RA who wish to conceive in clinical practice.
Methods ETN monotherapy was started at our clinic in patients with RA who wish to have a baby. ETN treatment was discontinued, once pregnancy was confirmed. If symptoms recurred after delivery, ETN was reintroduced. For these patients, the course of disease activity, the clinical course after pregnancy, and neonatal growth status after birth were retrospectively analyzed.
Results Ten patients who successfully became pregnant after the introduction of ETN before October 2013 were included in the analysis. Of these, 8 gave birth, 1 was pregnant, and 1 experienced abortion. The mean score of 28-joint disease activity score using C-reactive protein (DAS28-CRP) levels significantly decreased from 2.92 at the start of therapy to 2.02 at the discontinuation of therapy (when pregnancy was confirmed). For patients for whom ETN was reintroduced because of relapse of RA after the discontinuation of ETN, the mean duration of the drug withdrawal was 310.2 days. The DAS28-CRP score significantly decreased from 3.09 at the reintroduction of ETN to 2.44 at 12 weeks after the resumption. No adverse events were reported, and no abnormalities were found in the observation of neonatal growth status after birth, etc.
Conclusions Aggressive treatment with biological agents should be used in patients with RA who wish to conceive as necessary. ETN monotherapy was able to be used safely by discontinuing the treatment when pregnancy was confirmed. For its low immunogenicity, ETN may be reintroduced after interruption even though RA relapses.
Barrett JH, et al. Arthritis Rheum 1999;42:1219-1227
Disclosure of Interest None declared