Friday, 19 Jul 2019

You are here

Best of 2018: The Safety of Paternal Exposure to DMARDs and Biologics

Pregnancy and drug safety is a complex issue, often with limited information about maternal drug exposure on the offspring. Greater uncertainty exists when considering whether paternal exposure may also influence fetal outcomes.

A systematic review examined the effect of disease modifying anti-rheumatic drugs (DMARDs) on male fertility and if peri-conception (within 3 months) paternal exposure was detrimental to fetal outcomes.

A literature search up to September 2017, identified 233 potentially relevant papers; 84 papers were included in the final analysis.

Available data on over 611 male DMARD exposures and over 5986 pregnancies conceived during paternal exposure demonstrated the following findings:

  • As was previously shown, cyclophosphamide and sulfasalazine significantly affected spermatogenesis
  • Biologic exposures (to anti-TNF therapies, abatacept, rituximab) demonstrated no hazard for fertility or pregnancy outcomes
  • DMARD exposures (azathioprine, cyclosporine A, hydroxychloroquine, leflunomide, methotrexate or mycophenolate mofetil) also did not affect fertility or pregnancy outcomes.
  • Inconclusive: no conclusions can be drawn on the following agents, largely for a lack of data - IVIG, tacrolimus, golimumab, anakinra or belimumab.

Treatment with these agents in men was not associated with impaired fertility. Moreover, treatment with the above noted agents appears to be safe for those men who are trying to conceive or those who are involved in accidental conception.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

EHR-Related Adverse Events Usually Involve Medications

Concerns about the unintended risks inherent in electronic health records (EHR) by analysis of EHR–related harms identified from large database of malpractice suits and claims; they found that EHR related adverse events exist, and may be associated with an severe harms and uncommonly, death.

Methotrexate Use Not Linked to Interstitial Lung Disease in RA

People with rheumatoid arthritis have a significant risk of developing interstitial lung disease (RA-ILD), yet there is often a question as to whether methotrexate (MTX) exposure can cause or worsen ILD.  A controlled cohort study suggests that MTX use is not associated with an increased risk of RA-ILD and instead, there is evidence suggesting MTX use may delay the onset of ILD.

FDA Adds Boxed Warning to Sleep Drugs

The Food and Drug Administration (FDA) added a Boxed Warning to several sleep medications (e.g., eszopiclone, zaleplon, and zolpidem), warning rare but serious injuries may occur as a result of abnormal sleep behaviors (sleepwalking, sleep driving, and engaging in other activities while not fully awake) when taking sleep medications. These complex sleep behaviors have also resulted in deaths.

Update on Vaccines in Autoimmune Patients

Although both the disease and the treatment for it in rheumatology patients may work at cross-purposes with immunizations, only a very few vaccines are absolutely contraindicated in this population, an infectious disease specialist told rheumatologists here.

RheumNowLive On Demand: Infection Prevention and Management with Newer Agents - Jack Cush, MD

A clip from RheumNow Live On Demand. You can access the full library of content from the meeting.