Journal Article

The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation

Chambers, Christina, Förger, Frauke, Vencovsky, Jiri, Caeyers, Nele, Tincani, Angela, Dolhain, Radboud, Hoeltzenbein, Maria, Cutolo, Maurizio, da Silva, Josè, Zink, Angela, Ruiz-Irastorza, Guillermo, Cetin, Irene, Götestam Skorpen, Carina, Elefant, Elisabeth, Khamashta, Munther, Zumbühl, Claudia, Østensen, Monika, Costedoat-Chalumeau, Nathalie, Nelson-Piercy, Catherine, Fischer-Betz, Rebecca

2016

Overview

A European League Against Rheumatism (EULAR) task force was established to define points to consider on use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Based on a systematic literature review and pregnancy exposure data from several registries, statements on the compatibility of antirheumatic drugs during pregnancy and lactation were developed. The level of agreement among experts in regard to statements and propositions of use in clinical practice was established by Delphi voting. The task force defined 4 overarching principles and 11 points to consider for use of antirheumatic drugs during pregnancy and lactation. Compatibility with pregnancy and lactation was found for antimalarials, sulfasalazine, azathioprine, ciclosporin, tacrolimus, colchicine, intravenous immunoglobulin and glucocorticoids. Methotrexate, mycophenolate mofetil and cyclophosphamide require discontinuation before conception due to proven teratogenicity. Insufficient documentation in regard to fetal safety implies the discontinuation of leflunomide, tofacitinib as well as abatacept, rituximab, belimumab, tocilizumab, ustekinumab and anakinra before a planned pregnancy. Among biologics tumour necrosis factor inhibitors are best studied and appear reasonably safe with first and second trimester use. Restrictions in use apply for the few proven teratogenic drugs and the large proportion of medications for which insufficient safety data for the fetus/child are available. Effective drug treatment of active inflammatory rheumatic disease is possible with reasonable safety for the fetus/child during pregnancy and lactation. The dissemination of the data to health professionals and patients as well as their implementation into clinical practice may help to improve the management of pregnant and lactating patients with rheumatic disease.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier Limited
• Subject: Abnormalities, Drug-Induced - prevention & control / Antiparasitic agents / Antirheumatic Agents - adverse effects / Antirheumatic Agents - therapeutic use / Biological Products - adverse effects / Biological Products - therapeutic use / Birth weight / Breastfeeding & lactation / Congenital diseases / Data collection / Delphi Technique / DMARDs (biologic) / DMARDs (synthetic) / Drugs / Female / Fetuses / Humans / Immunosuppressive agents / Infant, Newborn / Lactation / Libraries / Literature reviews / Maternal-Fetal Exchange / Miscarriage / Nursing / Preconception Care - methods / Pregnancy / Pregnancy Complications - drug therapy / Pregnancy Outcome / Prenatal Exposure Delayed Effects / Recommendation / Rheumatic Diseases - drug therapy / Systematic review / Task forces / Treatment