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Women on biologics are likely to halt these drugs once pregnant
Among pregnant women taking biologics for autoimmune diseases, there is a significant likelihood of discontinuation in certain populations, according to findings.
Researchers evaluated data from the Population Data British Colombia (Population Data BC) and the BC Perinatal Database Registry (BCPDR) to identify 131 women (144 pregnancies) with one or more autoimmune diseases for which a biologic could be indicated. Women and their associated pregnancies were included if they had ICD-9/10 codes for a specific autoimmune disease and filled a prescription for a biologic during the study period. The women gave birth between Jan. 1, 2002 and Dec. 31, 2012. The researchers used multilevel logistic regression models, fitted with binomial generalized estimating equations, to evaluate correlations between drug discontinuation and several factors. The most common autoimmune diseases identified were rheumatoid arthritis, inflammatory bowel disease and psoriasis. The most common biologics used were infliximab, etanercept and adalimumab.
Researchers found that during the study period, there was an increase in biologics use in this cohort (from 0% in 2002 to 5.7% in 2012. A small decrease in biologics use was seen between 2010 and 2011, and an increase again thereafter.
During the period prior to conception, biologics use remained relatively stable, from 1.2% of all pregnancies among women with autoimmune diseases in the 12 months to 9 months before conception to 1.3% in the 3 months before conception.
In terms of new initiation of biologics, this percentage went from 0.1% to 0.2% during the preconception period. Between conception and delivery, the percentage of new starts decreased. Thirty-one percent of women stopped using their biologic within the third trimester of pregnancy. This pattern was consistent during the second trimester, with 38% of women discontinuing biologic treatment during that trimester. Of those women who were on a biologics regimen in the second trimester, 98% remained on treatment in the third trimester.
The likelihood of stopping treatment was 13-times higher in the second trimester vs. the first trimester, and was similar in comparing the third to first trimester. However, no disparity was seen in the risk of biologics cessation between the second and third trimesters (OR: 0.99).
The odds of discontinuing biologics were three-times higher in women with rheumatoid arthritis vs. those with inflammatory bowel disease.
“Overall, from 2002 to 2012, there was increasing biologics utilization in the preconception and pregnancy periods of B.C. women with autoimmune disease, consistent with that observed in other studies,” the researchers wrote. “These patterns showed a sharp rise in biologics use over the 10-year period, and those who used biologics were highly likely to discontinue their treatment once pregnant. The concern highlighted by our study is that this discontinuation pattern was occurring irrespective of changes in certain indicators of disease activity and use of concomitant treatments.” - by Jennifer Byrne
Disclosure: Lynd reports receiving honoraria from Boehringer Ingelheim and Pfizer Canada for consulting services unrelated to the present study.
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Tsao NW, et al. Arthritis Care Res. 2017;doi:10.1002/acr.23434.