The time of equipoise on the use of biological DMARDs in for inflammatory arthritis during pregnancy is finally over: a reappraisal of evidence to optimise pregnancy management

doi:10.1016/S2665-9913(24)00097-3

Review

. 2024 Aug;6(8):e546-e559.

doi: 10.1016/S2665-9913(24)00097-3. Epub 2024 Jun 11.

The time of equipoise on the use of biological DMARDs in for inflammatory arthritis during pregnancy is finally over: a reappraisal of evidence to optimise pregnancy management

Ian Giles¹, Iona Thorne², Nanna Surlemont Schmidt³, Claire Reid⁴, Amy Crossley⁴, Monica Panca⁵, Nick Freemantle⁶, Clare Tower⁷, Shouvik Dass⁸, Shefali K Sharma⁹, David Williams¹⁰, Sean O'Neill¹¹, Radboud J E M Dolhain¹², Nataša Toplak¹³, Kenneth Hodson¹⁴, Catherine Nelson-Piercy¹⁵, Megan E B Clowse¹⁶

Affiliations

¹ Centre for Rheumatology, Division of Medicine, University College London, London, UK. Electronic address: i.giles@ucl.ac.uk.
² Chelsea and Westminster Hospital NHS Trust, London, UK.
³ Danish Centre for Expertise in Rheumatology (CeViG), Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark; Thrombosis and Haemostasis, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁴ Department of Rheumatology, UCLH, London, UK.
⁵ Comprehensive Clinical Trials Unit, University College London, London, UK.
⁶ Institute of Clinical Trials and Methodology, University College London, London, UK.
⁷ Obstetrics and Maternal and Fetal Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.
⁸ Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁹ Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
¹⁰ UCL Elizabeth Garrett Anderson Institute for Women's Health, London, UK.
¹¹ Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia.
¹² Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, Netherlands.
¹³ Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.
¹⁴ Obstetrics and Maternal Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; UK Teratology Information Service, Newcastle, UK.
¹⁵ Maternity Department, Guy's and St Thomas' Hospital, London, UK.
¹⁶ Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, NC, USA.

PMID: 38876126
DOI: 10.1016/S2665-9913(24)00097-3

Review

The time of equipoise on the use of biological DMARDs in for inflammatory arthritis during pregnancy is finally over: a reappraisal of evidence to optimise pregnancy management

Ian Giles et al. Lancet Rheumatol. 2024 Aug.

. 2024 Aug;6(8):e546-e559.

doi: 10.1016/S2665-9913(24)00097-3. Epub 2024 Jun 11.

Authors

Affiliations

¹ Centre for Rheumatology, Division of Medicine, University College London, London, UK. Electronic address: i.giles@ucl.ac.uk.
² Chelsea and Westminster Hospital NHS Trust, London, UK.
³ Danish Centre for Expertise in Rheumatology (CeViG), Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark; Thrombosis and Haemostasis, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁴ Department of Rheumatology, UCLH, London, UK.
⁵ Comprehensive Clinical Trials Unit, University College London, London, UK.
⁶ Institute of Clinical Trials and Methodology, University College London, London, UK.
⁷ Obstetrics and Maternal and Fetal Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.
⁸ Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁹ Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
¹⁰ UCL Elizabeth Garrett Anderson Institute for Women's Health, London, UK.
¹¹ Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia.
¹² Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, Netherlands.
¹³ Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.
¹⁴ Obstetrics and Maternal Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; UK Teratology Information Service, Newcastle, UK.
¹⁵ Maternity Department, Guy's and St Thomas' Hospital, London, UK.
¹⁶ Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, NC, USA.

PMID: 38876126
DOI: 10.1016/S2665-9913(24)00097-3

Abstract

Active inflammatory arthritis in pregnancy is associated with an increased risk of adverse pregnancy outcomes. Treatment of active inflammation and maintenance of low disease activity with medication reduces these risks. Therapeutic decisions on disease-modifying antirheumatic drugs (DMARDs) in pregnancy are complicated by safety concerns, which have led to inappropriate withdrawal of treatment and consequential harm to mother and fetus. Studies of inflammatory arthritis in pregnancy have consistently shown minimal safety concerns with the use of biological DMARDs and an increased risk of disease flare with discontinuation of biological DMARDs. It is our opinion that during pregnancy, the benefits of disease control with biological DMARDs, when required in addition to conventional synthetic DMARDs, outweigh the risks. In this Series paper, we review the reasons for reconsideration of equipoise and propose an agenda for future research to optimise the use of biological DMARDs in inflammatory arthritis during pregnancy.

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Conflict of interest statement

Declaration of interests IG has received grants from Union Chimique Belge (UCB), honoraria from MGP as a coauthor on an educational review article in 2020, and speaker fees from UCB, and has participated in advisory boards for UCB. IT has received speaker fees from UCB. CN-P has received speaker fees from UCB and participated in advisory boards for UCB. CT has received honoraria to provide an online lecture in a related area in 2022 and to be coauthor on an educational review article in 2020 (from MGP), and has acted as an expert witness for obstetric cases in the UK. SD has received speaker and consulting fees from UCB. NF has received consulting fees from ALK, Sanofi Aventis, Gideon Richter, Abbot, Galderma, AstraZeneca, Ipsen, Vertex, Thea, Novo Nordisk, Aimmune, and Ipsen; speaker fees from Abbott Singapore; and has participated in advisory boards for Orion. RJEMD has received grants paid to his department from the Dutch Arthritis Association, ZonMw, UCB, and Galapagos; consulting fees from Galapagos and UCB; and speaker fees from UCB, Roche, AbbVie, Genzyme, Novartis, AstraZeneca, and Eli Lilly; and has participated in advisory boards for Galapagos and UCB. MEBC has received grants and consulting fees from GSK and UCB and has participated in advisory boards for MotherToBaby. All other authors declare no competing interests.

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The time of equipoise on the use of biological DMARDs in for inflammatory arthritis during pregnancy is finally over: a reappraisal of evidence to optimise pregnancy management

Affiliations

The time of equipoise on the use of biological DMARDs in for inflammatory arthritis during pregnancy is finally over: a reappraisal of evidence to optimise pregnancy management

Authors

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