Treatment of rheumatoid arthritis during pregnancy: present and future

ABSTRACT

Introduction: For the management of rheumatoid arthritis patients who plan to become pregnant, both disease activity and therapeutic regimens have to be taken into consideration. In the case of stable inactive disease, pregnancy can be planned and therapy can be adjusted with drugs compatible with pregnancy.

Areas covered: Drugs to be discontinued before pregnancy are methotrexate, leflunomide, tocilizumab, rituximab, abatacept and tofacitinib. Pregnancy compatible disease modifying drugs are antimalarial drugs and sulfasalazine. TNF-inhibitors can be continued during the first half of pregnancy, yet if indicated during the third trimester TNF-inhibitors with a low rate of transplacental passage should be used. Glucocorticoids may be considered at the lowest effective dose throughout pregnancy. Non-selective COX-inhibitors can be continued until gestational week 32.

Expert commentary: Together, a tailored treatment throughout pregnancy is possible with reasonable safety. Controlling disease activity during pregnancy is important for both, maternal and fetal health.

KEYWORDS:

• Pregnancy
• rheumatoid arthritis
• DMARD
• biologic agents
• TNF blockers

Declaration of interests

PM Villiger has acted as a consultant or speaker for Roche, Novartis, MSD, Pfizer, Actelion, Celgene, AbbVie, UCB, BMS and Amgen, Mepha. F Foerger has consultation and speaking engagements with Mepha, UCB and Roche. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.