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Desai and coworkers analyzed public and private insurance claims data (2001-2012) to assess patterns of drug use in pregnant woment with RA, SLE, PsA and AS. Specifically, they looked at immunosuppressive drug use in the 3 months preceding and during pregnancy.
A total of 2,645 women actively treated with immunomodulatory agents prior to pregnancy were included. More women with PsA or AS stopped these immunomodulatory prescriptions upon becoming pregnant (61%) compared with women diagnosed with SLE (26%) or RA (34.5%). From the first to the third trimester, the proportion of women filling prescriptions for immunomodulatory agents decreased across all indications.
Overall, steroids (48.4%) and hydroxychloroquine (27.1%) were the most frequently used agents in pregnancy. Steroid prescription refills during pregnancy fell significantly from 54.4 to 42.4; rates for biologics increased from 5.1 to 16.6 between 2001 and 2012 (p<0.001).
While steroids and hydroxychloroquine remain the most widely prescribed treatments during pregnancy, biologic use is increasing in recent years. Presumably this reflects the increasing reports of TNF inhibitor safety in pregnant women.