The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation
Language English Country United States Media print-electronic
Document type Consensus Development Conference, Journal Article, Systematic Review
PubMed
26888948
DOI
10.1136/annrheumdis-2015-208840
PII: S0003-4967(24)01873-9
Knihovny.cz E-resources
- Keywords
- DMARDs (biologic), DMARDs (synthetic), Nursing, Treatment,
- MeSH
- Abnormalities, Drug-Induced prevention & control MeSH
- Antirheumatic Agents adverse effects therapeutic use MeSH
- Biological Products adverse effects therapeutic use MeSH
- Delphi Technique MeSH
- Pregnancy Complications drug therapy MeSH
- Lactation * MeSH
- Humans MeSH
- Maternal-Fetal Exchange MeSH
- Infant, Newborn MeSH
- Preconception Care methods MeSH
- Rheumatic Diseases drug therapy MeSH
- Pregnancy MeSH
- Pregnancy Outcome MeSH
- Prenatal Exposure Delayed Effects MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Consensus Development Conference MeSH
- Systematic Review MeSH
- Names of Substances
- Antirheumatic Agents MeSH
- Biological Products MeSH
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.
Department of Mother and Child Hospital Luigi Sacco University of Milano Milano Italy
Department of Pediatrics University of California San Diego La Jolla USA
Department of Rheumatology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
Department of Rheumatology Immunology and Allergology University Hospital of Bern Bern Switzerland
Department of Rheumatology University Hospital Coimbra Portugal
Department of Rheumatology University Hospital of Düsseldorf Duesseldorf Germany
EULAR Social Leagues Patients' representative Leuven Belgium
EULAR Social Leagues Patients' representative Zürich Switzerland
Institute of Rheumatology Praha Czech Republic
Women's Health Academic Centre St Thomas' Hospital London UK
References provided by Crossref.org
EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis