Treat-to-target approach improves fertility in women with rheumatoid arthritis
Click Here to Manage Email Alerts
WASHINGTON — Women with rheumatoid arthritis demonstrate times to pregnancy that were “nearly equal to the general population” when treated under a treat-to-target paradigm, according to data presented at ACR Convergence 2024.
“For women with rheumatoid arthritis, [infertility] might be more troublesome,” Radboud Dolhain, MD, PhD, of Erasmus University Medical Center, in the Netherlands, told attendees. “Fertility is impaired in women with rheumatoid arthritis.”
To examine whether a treat-to-target strategy using sulfasalazine, hydroxychloroquine and, if needed, a TNF inhibitor or low-dose prednisone, would lead to a shorter time to pregnancy in women with RA, Dolhain and colleagues analyzed data from 245 patients in the Preconception Counseling in Active RA(PreCARA) study. According to the researchers, all patients within the PreCARA study underwent a treat-to-target approach. Dolhain and colleagues then compared fertility-related outcomes in that group with data from 215 patients in the Pregnancy-induced Amelioration of RA (PARA) cohort, which did not use a treat-to-target strategy.
“They were treated by their rheumatologist but visited by researchers from Erasmus University,” Dolhain said.
Time to pregnancy was assessed by measuring the interval between unprotected sexual intercourse and the onset of the last menstrual period. The researchers defined infertility as the inability to conceive within 1 year of initiation.
During the pre-conception periods, participants from the PreCARA cohort demonstrated a DAS28 CRP disease activity score of 2.33, compared with a DAS28 of 3.84 among those from the PARA cohort.
In the PreCARA group, 3% of patients did not take any medication during the preconception period, while 36% of those in the PARA study were not medicated.
Among those taking medications, during the preconception period, NSAIDs were used by 13% of PreCARA patients and 24% of PARA patients.
Further data from the PreCARA group showed that 23% of 96 patients using prednisone used daily doses higher than 7.5 mg, compared with 48% of 85 PARA patients who used this dose of prednisone each day.
Although 53% of patients in the PreCARA study used TNF inhibitors in the pre-conception period, compared with just 3% in the PARA cohort during the same period.
According to the researchers, the median time to pregnancy was 84 days in the treat-to-target PreCARA group, and 196 days in the PARA group.
“This means that more than 50% of women in this treat-to-target paradigm conceived within 3 months, which was far lower than in the PARA cohort,” Dolhain said.
Time to pregnancy exceeded 12 months in 23% of PreCARA patients, compared with 42% among the PARA cohort.
“Fertility in women with RA is nearly equal to the general population when treated according to a treat-to-target approach aimed at remission of disease,” Dolhain said.
Collapse
Dolhain R. Abstract #1647 Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
Read more about
Click Here to Manage Email Alerts