Nothing Special   »   [go: up one dir, main page]
Skip to main content

Advertisement

Springer Nature Link
Log in

Effect of biologic disease-modifying anti-rheumatic drugs for patients with rheumatoid arthritis who hope to become mothers

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Objectives

We examined the effect of biologic disease-modifying anti-rheumatic drugs on the time to pregnancy in patients with rheumatoid arthritis who hope to become mothers. Additionally, we evaluated adverse pregnancy outcomes and risk factors of these drugs.

Method

We retrospectively investigated 25 pregnancies of 19 patients who were taking disease-modifying anti-rheumatic drugs. In 15 pregnancies, patients continued biologic disease-modifying anti-rheumatic drugs until conception (group A). In 10 pregnancies, patients discontinued biologic disease-modifying anti-rheumatic drugs and conventional synthetic disease-modifying anti-rheumatic drugs at the time of planning to conceive (group B). We used tumor necrosis factor inhibitors (certolizumab pegol and etanercept) for group A patients.

Results

The mean time to pregnancy was shorter in group A than in group B (5.9 ± 3.8 vs 11.0 ± 6.5 months, P = 0.04). The mean birth weight of newborns was lighter in group B than in group A (2446.5 ± 352.4 vs 2969.4 ± 459.9 g, P = 0.007). There were no significant differences in the rates of preterm birth, light-for-date, and premature rupture of the membranes between the groups. In patients with preterm birth or light-for-date newborns, the mean dose of corticosteroids during pregnancy was significantly higher compared with that in those with full-term birth or non-light-for-date newborns (P = 0.02, P < 0.01, respectively).

Conclusions

In patients with rheumatoid arthritis who hope to conceive, continuing biologic disease-modifying anti-rheumatic drugs at the time of conception could shorten the time to pregnancy. Using biologic disease-modifying anti-rheumatic drugs before pregnancy does not affect abortion, preterm birth, light-for-date, and premature rupture of the membranes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Clowse ME, Chakravarty E, Costenbader KH et al (2012) Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res 64:668–674

    Article  Google Scholar 

  2. Jawaheer D, Zhu JL, Nohr EA, Olsen J (2011) Time to pregnancy among women with rheumatoid arthritis. Arthritis Rheum 63:1517–1521

    Article  PubMed  PubMed Central  Google Scholar 

  3. Brouwer J, Hazes JM, Laven JS et al (2015) Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis 74:1836–1841

    Article  CAS  PubMed  Google Scholar 

  4. de Man YA, Haze JM, van der Heide H et al (2009) Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: results of a national prospective study. Arthritis Rheum 60:3196–3206

    Article  PubMed  Google Scholar 

  5. Bharti B, Lee SJ, Lindsay SP, Wingard DL, Jones KL, Lemus H, Chambers CD (2015) Disease severity and pregnancy outcomes in women with rheumatoid arthritis: results from the Organization of Teratology Information Specialists Autoimmune Diseases in Pregnancy Project. J Rheumatol 42:1376–1382

    Article  PubMed  Google Scholar 

  6. Zbinden A, van den Brandt S, Østensen M, Villiger PM, Förger F (2018) Risk for adverse pregnancy outcome in axial spondyloarthritis and rheumatoid arthritis: disease activity matters. Rheumatology (Oxford) 57:1235–1242

    Article  Google Scholar 

  7. Nergaard M, Larsson H, Pedersen L et al (2010) Rheumatoid arthritis and birth outcomes: a Danish and Swedish nationwide prevalence study. J Intern Med 268:329–337

    Article  Google Scholar 

  8. Wallenius M, Skomsvill JF, Irgens LM et al (2011) Pregnancy and delivery in women with chronic inflammatory arthritides with a specific focus on first birth. Arthritis Rheum 63:1534–1542

    Article  PubMed  Google Scholar 

  9. Lin HC, Chen SF, Lin HC, Chen YH (2010) Increased risk of adverse pregnancy outcomes in women with rheumatoid arthritis: a nationwide population-based study. Ann Rheum Dis 69:715–717

    Article  PubMed  Google Scholar 

  10. Rom AL, Wu CS, Olsen J, Kjaergaard H, Jawaheer D, Hetland ML, Vestergaard M, Mørch LS (2014) Fetal growth and preterm birth in children exposed to maternal or paternal rheumatoid arthritis: a nationwide cohort study. Arthritis Rheum 66:3265–3273

    Article  Google Scholar 

  11. Flint J, Panchal S, Hurrell A, van de Venne M, Gayed M, Schreiber K, Arthanari S, Cunningham J, Flanders L, Moore L, Crossley A, Purushotham N, Desai A, Piper M, Nisar M, Khamashta M, Williams D, Gordon C, Giles I, on behalf of the BSR and BHPR Standards, Guidelines and Audit Working Group (2016) BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford) 55:1693–1697

    Article  CAS  Google Scholar 

  12. Gotestam Skorpen C, Hoelzenbein M, Tincani A et al (2016) The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 75:795–810

    Article  CAS  PubMed  Google Scholar 

  13. Komaki F, Komaki MDY et al (2017) Outcome of pregnancy and neonatal complications with anti-tumor necrosis factor-α use in females with immune mediated diseases; a systematic review and meta-analysis. J Autoimmun 76:38–52

    Article  PubMed  Google Scholar 

  14. Winger EE, Reed JL (2008) Treatment with tumor necrosis factor inhibitors and intravenous immunoglobulin improves live birth rates in women with recurrent spontaneous abortion. Am J Reprod Immunol 60:8–16

    Article  CAS  PubMed  Google Scholar 

  15. Winger EE, Reed JL, Ashoush S, Ahuja S, el-Toukhy T, Taranissi M (2009) Treatment with adalimumab (Humira) and intravenous immunoglobulin improves pregnancy rates in women undergoing IVF. Am J Reprod Immunol 61:113–120

    Article  CAS  PubMed  Google Scholar 

  16. Clark DA (2010) Anti-TNFalpha therapy in immune-mediated subfertility: state of the art. J Reprod Immunol 85:15–24

    Article  CAS  PubMed  Google Scholar 

  17. Brouwer J, Laven JS, Hazes JM et al (2013) Levels of serum anti-Müllerian hormone, a marker for ovarian reserve in women with rheumatoid arthritis. Arthritis Care Res (Hoboken) 65:1534–1538

    Article  CAS  Google Scholar 

  18. Hill JA, Polgar K, Anderson DJ (1995) T-helper 1-type immunity to trophoblast in women with recurrent spontaneous abortion. JAMA 273:1933–1936

    Article  CAS  PubMed  Google Scholar 

  19. Krishnan L, Guilbert LJ, Wegmann TG et al (1996) Helper 1 response against Leishmania major in pregnant C57BL/6 mice increases implantation failure and fetal resorption: correlation with increased IFN-γ and TNF and reduced IL-10 production by placental cells. J Immunol 156:653–662

    CAS  PubMed  Google Scholar 

  20. Mariette X, Forger F, Abraham B et al (2018) Lack of placental transfer of certolizumab pegol during pregnancy: results from CRIB, a prospective, postmarketing, pharmacokinetic study. Ann Rheum Dis 77:228–233

    Article  CAS  PubMed  Google Scholar 

  21. Clowse ME, Scheuerle AE, Chambers C et al (2018) Pregnancy outcomes after exposure to certolizumab pegol: updated results from a pharmacovigilance safety database. Arthritis Rheumatol 70:1399–1407

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Gur C, Diav-Citrin O, Shechtman S, Arnon J, Ornoy A (2004) Pregnancy outcome after first trimester exposure to corticosteroids: a prospective controlled study. Reprod Toxicol 18:93–101

    Article  CAS  PubMed  Google Scholar 

  23. Park-Wyllie L, Mazzotta P, Pastuszak A, Moretti ME, Beique L, Hunnisett L, Friesen MH, Jacobson S, Kasapinovic S, Chang D, Diav-Citrin O, Chitayat D, Nulman I, Einarson TR, Koren G (2000) Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 62:385–392

    Article  CAS  Google Scholar 

Download references

Acknowledgments

We thank Ellen Knapp, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan

    Hiromi Shimada, Tomohiro Kameda, Shusaku Nakashima, Risa Wakiya, Mikiya Kato, Taichi Miyagi, Mai Mahmoud Fahmy Mansour, Norimitsu Kadowaki & Hiroaki Dobashi

  2. Department of Perinatology and Gynecology, Faculty of Medicine, Kagawa University, Kagawa, Japan

    Kenji Kanenishi & Toshiyuki Hata

  3. Department of Hygiene, Faculty of Medicine, Kagawa University, Kagawa, Japan

    Nobuyuki Miyatake

Authors
  1. Hiromi Shimada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomohiro Kameda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenji Kanenishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nobuyuki Miyatake
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shusaku Nakashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Risa Wakiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mikiya Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Taichi Miyagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mai Mahmoud Fahmy Mansour
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Toshiyuki Hata
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Norimitsu Kadowaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hiroaki Dobashi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiromi Shimada.

Ethics declarations

Disclosures

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shimada, H., Kameda, T., Kanenishi, K. et al. Effect of biologic disease-modifying anti-rheumatic drugs for patients with rheumatoid arthritis who hope to become mothers. Clin Rheumatol 38, 1453–1458 (2019). https://doi.org/10.1007/s10067-019-04450-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-019-04450-3

Keywords

Search

Navigation