Background Biologic disease- modifying antirheumatic drugs (b DMARDs) are used often by patients with ankylosing spondylitis (AS) around the time of conception. Pregnancy outcomes in couples where men were exposed to TNF alpha blockers needs to be carefully examined, as information regarding paternal exposure may highly influence further couple counseling. Scarce information regarding the men fertility, pregnancy outcome and risk for congenital malformations associated with chronic TNF blockers treatment prior to conception is available.

Objectives To examine pregnancy outcome and decision to conception time frame in the partners of AS male patients who were exposed to TNF alpha blockers before conception compared to the outcomes in age matched men from general population.

Methods Outcomes of pregnancies in fathering men exposed to continuous long term (>12 months) anti TNF alpha blockers therapies were compared with outcomes in age matched reference subjects between 2008–2015.

Results Out of 127 men diagnosed with AS, mean age (37.3 ± 10.3 years), disease onset (11.7 ± 10.5 years) treated with different bDMARDs in monotherapy, 13 patients were exposed to minimum 12 months preconception therapy. One patient received Infliximab 5 mg/ kg/ 8 weeks (72 months), 9 patients received Etanercept 50 mg/ week (34.6 ± 19.4 months), 3 patients received Adalimimab 40 mg/ 2 weeks (25.25 ± 10.11 months) monotherapy. One patient fathered 2 children after 42 months and 60 months of preconception Etanercept exposure. One patient had a recent switch from Adalimumab (24 months) to Etanercept introduced 2 months prior to conception. One patient with Etanercept therapy (60 months) has a partner with an ongoing 10 weeks pregnancy. Thirteen men fathered 14 healthy, on term delivered children. All newborns had normal weight and no signs of neonatal patology. No cases of abortion, preeclampsia, eclampsia, preterm delivery or neonatal death were reported in this group. Forty-five age matched healthy men (35.1 ± 1.2 years old) fathered 37 children: 35 healthy, one with cleft lip and one with Down syndrome. Eight pregnancies ended with abortion, 3 spontaneous and five by request. The time frame between mental decisions for reproduction to conception was 14.3 ± 3.3 months vs 7.7 ±1.2 months in the patients group vs reference group.

Conclusions Long term preconception paternal exposure to TNF alpha blockers is not associated with an increase in adverse pregnancy outcomes. All born children were healthy. The interval between decision for reproduction and conception is longer in patients with AS treated with b DMARDs in comparison to general population.

1. Micu MC, Micu R, Surd S, Gârlovanu M, Bolboacă S D, Ostensen M. TNF-a inhibitors do not impair sperm quality in males with ankylosing spondylitis after short-term

2. or long-term treatment. Rheumatology 2014;53:1250–1255.

3. Wallenius M, Lie E, Daltveit AK, et al. No Excess Risks in Offspring With Paternal Preconception Exposure to Disease-Modifying Antirheumatic Drugs. Arthritis & Rheumatism 2015; 67(1):296–301.

Disclosure of Interest None declared