Friday, 20 Jul 2018

You are here

Patterns of Biologic Use During Autoimmune Pregnancy

While it is highly desirable to avoid medications during conception and pregnancy, statistics show that >90% of women take at least one drug during pregnancy and nearly half will take 3 or more medications during pregnancy.

This becomes problematic in autoimmune patients, many of whom are women of child bearing potential, who may have active disease that mandates the use of corticosteroids, immunosuppressives or biologics to maintain maternal health.

This issue was studied by Tsao et al who showed increased biologic utilization of biologics and high rates of discontinuation during pregnancy in women with autoimmune disease. 

A Canadian cohort of women with one or more autoimmune diseases was studied between January 1st, 2002 and December 31st, 2012; those with >1 biologic before, or during, pregnancy were included.

Among 6,218 women (8,431 pregnancies) with autoimmune diseases, they found 131 women (144 pregnancies) exposed to a biologic before or during pregnancy.  This included women with RA (51%), IBD 46%, JIA 8%, AS 6% and MS 5%. 

Biologic use increased over 12 years from 0% to 5.7% by 2012 (p<0.001). Within the first trimester of pregnancy, 31% (34/110) of women discontinued their biologic and 38% (30/79) discontinued in the second trimester, while 98% (50/51) of those who were on treatment in the second trimester remained on treatment in the third trimester.

Women with rheumatoid arthritis (RA) had three times greater odds (OR 3.40 [95%CI 1.33-8.71]) of discontinuing biologics during pregnancy, compared to those with inflammatory bowel disease.

These data suggest the need for more research regarding the use, risks and benefits of biologics on fetal and maternal health.

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

Add new comment

More Like This

Defining Refractory RA by Biologic Use

A study from the  British Society for Rheumatology Biologics Register (BSRBR) has shown that biologic refractory disease is seen in at least 6% of patients who have ever received a biologic DMARD (bDMARDs).

IL-23 Inhibitor Fails in Ankylosing Spondylitis

A study of the IL-23 risankizumab in active ankylosing spondylitis (AS) patients failed to show efficacy and did not meet primary efficacy endpoints in a 6-month trial.

Five Barriers to Biosimilar Adoption in the US

A recent Deloitte analysis of the biosimilar market in the USA suggests there are defined obstacles to biosimilar use that must be dealt with, especially as the current administration is seeking to lower drug prices and reduce out-of-pocket costs for US consumers.

EULAR 2018 - Day 4 Report

The EULAR 2018 wound down on Saturday with fewer oral presentations but many posters.  In my last report I put together a collection of impressions and some thematic highlights not covered in previous reports. Also some of these represent research and reporting trends – some healthy, others not so – that were evident at the EULAR 2018 meeting.

Pain 

High Biologic Blood Levels Increases the Risk of Infections in RA

A big concern of most is the risk of infection with use of tumour necrosis factor inhibitor (TNFi) and biologic drugs.  While studied in both trials and in post-marketing studies, it is unknown if infection risk is dose-dependent.

In abstract OP0229 UK researchers have shown high biologic blood levels are associates with an increased risk of total infections in RA, but not serious infetions.