Discontinuing TNF-inhibitors before gestational week 20 in well-controlled rheumatoid arthritis and juvenile arthritis is not associated with a disease worsening in late pregnancy.

Förger, Frauke; Bandoli, Gretchen; Luo, Yunjun; Robinson, Loan; Johnson, Diana L; Chambers, Christina D (2019). Discontinuing TNF-inhibitors before gestational week 20 in well-controlled rheumatoid arthritis and juvenile arthritis is not associated with a disease worsening in late pregnancy. Arthritis & rheumatology, 71(6), pp. 901-907. Wiley-Blackwell 10.1002/art.40821

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OBJECTIVE

To investigate whether the discontinuation of tumor necrosis factor inhibitors (TNFi) during pregnancy is associated with any changes of the disease course in women with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA).

METHODS

Pregnant women from the U.S. and Canada with RA and JIA were enrolled in the Organization of Teratology Information Specialists (OTIS) Autoimmune Diseases in Pregnancy Project, a prospective cohort study. Information about medication and disease activity (patient-reported outcome measures) were collected prior to gestational week 20 and at gestational week 32. Associations between patterns of TNFi continuation or discontinuation with disease activity changes were tested in unadjusted and multivariate analyses.

RESULTS

Among 490 women enrolled between 2005 and 2017 (397 with RA, 93 with JIA), 122 (24.9%) discontinued a TNFi before gestational week 20, 201 (41.0%) used a TNFi beyond week 20 and 167 (34.1%) did not use a TNFi during pregnancy. At the time of enrollment, disease activity was low to minimal in 72.9% of women. TNFi discontinuation was not associated with a clinically important worsening of patient reported outcome measures at the third trimester. Univariate but not multivariate analysis showed that women using TNFi beyond week 20 were more likely to experience improved disease activity scores at the third trimester.

CONCLUSION

Discontinuing a TNFi before gestational week 20 seems feasible in women with RA and JIA who enter pregnancy with well-controlled disease. This article is protected by copyright. All rights reserved.

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