Obstetric outcomes unaffected by maintaining TNF inhibition during pregnancy
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SAN DIEGO — In patients with chronic rheumatic inflammatory disease, those who continue TNF inhibition during pregnancy have similar obstetrical outcomes as those who cease treatment, according to data presented at ACR Convergence 2023.
Moreover, pregnant patients who maintained their use of TNF inhibitors experienced fewer severe maternal infections vs. those who stopped, the researchers wrote.
“As you may know, patients with rheumatic diseases such as lupus, rheumatoid arthritis and spondyloarthritis tend to present with worse pregnancy outcomes, compared with the general population,” Anna Molto, MD, PhD, HDR, of Cochin Hospital, in Paris, said at a press conference during the meeting. “We have learned from our inflammatory bowel disease colleagues that continuing TNF inhibition throughout pregnancy could help reduce this difference in the proportion of poor pregnancy outcomes.
“However, many rheumatologists are still reluctant, at least in our country in France, to continue TNF inhibitors during pregnancy, for many reasons, including safety and the infection risk,” she added. “Also, some patients refuse to continue.”
To compare obstetric outcomes among patients who maintain TNF inhibitors with those who stop treatment upon pregnancy, in a real-life setting, Molto and colleagues analyzed data from France’s nationwide health insurance database. The researchers included a total of 2,082 singleton pregnancies among patients treated with TNF inhibitors for chronic rheumatic inflammatory disease who became pregnant between 2008 and 2017. Among the included patients, 579 had rheumatoid arthritis and 1,503 had spondyloarthritis. A total of 1,497 discontinued TNF inhibitor treatment upon pregnancy.
Adverse pregnancy outcomes were defined as malformations, obstetrical complications and infections. The researchers used inverse probability weighted marginal models to compare outcomes between those who continued TNF inhibition and those who ceased treatment.
According to Molto and colleagues, maintaining TNF-inhibitor treatment was not associated with more adverse obstetrical or infant outcomes. In addition, the rate of severe maternal infections requiring hospitalization was significantly lower among those who continued treatment, at 0.2%, compared with 1.3% in the “stop treatment” group (adjusted RR = 0.2; 95% CI, 0.1-0.6).
“For rheumatologists who are reluctant to continue treatment during pregnancy because of the infection risk, that doesn’t seem to be a good reason to discontinue,” Molto said. “We will now, for the further analysis, try to gather information on the reason why when discontinuing treatment patients get more infections.”
Perspective
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This study highlights the importance of providing women with data that assist them in making critical medication decisions in controlling their inflammatory arthritis during pregnancy. When planning a pregnancy, or when pregnancy is confirmed, women will most often seek guidance from their rheumatology team to know what treatments are safe during their pregnancy, as well as postpartum should they decide to breastfeed. The rheumatology team needs to be aware of the most current data available and share resources with the expectant mother that will allow her to make the best possible decision on arthritis care during her pregnancy.
Additionally, having these conversations prior to pregnancy with patients can often provide reassurance through the family planning process, even in those who are not at this time planning a pregnancy. Studies such as this can aid both the patient and the provider in the shared decision-making process on appropriate treatments during pregnancy for the best possible outcomes for mother and baby.
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Molto A. Abstract 477. Presented at: ACR Convergence 2023; Nov. 10-15, 2023; San Diego.
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