BSR releases guidelines for DMARD use during pregnancy

The British Society for Rheumatology has released guidelines for the use of disease-modifying anti-rheumatic drugs during pregnancy.

“The management of patients with inflammatory rheumatic diseases during pregnancy is complicated by several factors, including an increased burden of pregnancy morbidity that is partly due to increased disease activity, and so it is vital to maintain adequate control of disease activity with medications that are compatible with pregnancy,” according to a press release from the society.

Among the highlights of the guidelines, the British Society for Rheumatology (BSR) recommends:

prednisolone as the corticosteroid of choice, which the group said is compatible during all trimesters;

use of hydroxychloroquine as an antimalarial prior to conception and throughout pregnancy;

discontinuation of methotrexate 3 months prior to conception and avoidance of this medication during the entire pregnancy;

avoidance of adalimumab and etanercept in the third trimester, and discontinuation of infliximab at 16 weeks of pregnancy. If these treatments are used later in pregnancy, live vaccinations should be avoided for the infant through age 7 months; and

certolizumab pegol as a treatment based on limited evidence that it is compatible in all trimesters of pregnancy.

“The BSR guidelines will enable medical practitioners to have a more confident and consistent approach to prescribing anti-rheumatic drugs in pregnancy and breastfeeding,” Ian Giles, PhD, FRCP, professor at the Centre for Rheumatology Research at the University College London Division of Medicine, said in the release. “I hope this approach will allow adequate control of inflammatory rheumatic disease activity and prevent the unnecessary withdrawal of disease ameliorating anti-rheumatic therapies which have not been shown to be harmful in pregnancy and breastfeeding.”

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