Background Rheumatic diseases are prevalent especially in the fertile ages for women. Biologic DMARDs (disease modifying anti-rheumatic drugs) are commonly used in the treatment of these patients and there is a growing concern while safety data in pregnancy is insufficient.
Objectives We herein documented our anti-TNF (tumor necrosis factor) drugs data whom using/used biologic drugs; adalimumab (ADA), infliximab (INF), etanercept (ETA), golimumab (GOL) and others in their pregnancy.
Methods 653 women with a history of biologic DMARD exposure were included (until December 2014) and 47 conception were documented form the medical files. 4 of patients whom couldn't be reached due to loss of follow up were excluded. Abortion was classified depending to patient's statements and medical reports. Age, pregnancy age, abortion with and before biologics, complications, disease activity, smoking, HAQ score, drug exposure were analyzed. Patients with secondary causes for miscarriage were also excluded.
Results Mean (33.3±10.3) and pregnancy age (31.9±9.9), disease distribution (22 AS, 14 RA, 5 PsA, 1 Behçet's disease, 1 Takayasu), drug exposure (20 ADA, 13 INF, 7 ETA, 3 GOL) was found and 7 miscarriages in 7 of the patients (5 AS, 2 RA) and 1 premature birth were detected. Mean abortion time was 7.2±3.2 weeks. 3 patients ADA, 2 patients INF, 1 patient ETA and 1 patient GOL usage was defined. Mean abortion age was 35.3±7.7 and that was higher than the other patients but there was not statistical significance. Disease activity, HAQ scores, smoking was not different between two groups.
Conclusions Anti-TNF drugs are well tolerated during pregnancy. However the wonder for the safety still exists. Elevated abortion rate in the late pregnancy with these drugs are remarkable. The discrepancy for each drug and its' own risk could not be demonstrated due to a need with higher patient numbers.
Ostensen M, Förger F. How safe are anti-rheumatic drugs during pregnancy?. Curr Opin Pharmacol. 2013 Jun;13(3):470-5.
Chambers CD, Johnson DL. Emerging data on the use of anti-tumor necrosis factor-alpha medications in pregnancy. Birth Defects Res A Clin Mol Teratol. 2012 Aug;94(8):607-11.
Disclosure of Interest None declared