TY - JOUR
T1 - The time of equipoise on the use of biological DMARDs in for inflammatory arthritis during pregnancy is finally over
T2 - a reappraisal of evidence to optimise pregnancy management
AU - Giles, Ian
AU - Thorne, Iona
AU - Schmidt, Nanna Surlemont
AU - Reid, Claire
AU - Crossley, Amy
AU - Panca, Monica
AU - Freemantle, Nick
AU - Tower, Clare
AU - Dass, Shouvik
AU - Sharma, Shefali K.
AU - Williams, David
AU - O'Neill, Sean
AU - Dolhain, Radboud J.E.M.
AU - Toplak, Nataša
AU - Hodson, Kenneth
AU - Nelson-Piercy, Catherine
AU - Clowse, Megan E.B.
N1 - Publisher Copyright: © 2024 Elsevier Ltd
PY - 2024/8
Y1 - 2024/8
N2 - Active inflammatory arthritis in pregnancy is associated with an increased risk of adverse pregnancy outcomes. Treatment of active inflammation and maintenance of low disease activity with medication reduces these risks. Therapeutic decisions on disease-modifying antirheumatic drugs (DMARDs) in pregnancy are complicated by safety concerns, which have led to inappropriate withdrawal of treatment and consequential harm to mother and fetus. Studies of inflammatory arthritis in pregnancy have consistently shown minimal safety concerns with the use of biological DMARDs and an increased risk of disease flare with discontinuation of biological DMARDs. It is our opinion that during pregnancy, the benefits of disease control with biological DMARDs, when required in addition to conventional synthetic DMARDs, outweigh the risks. In this Series paper, we review the reasons for reconsideration of equipoise and propose an agenda for future research to optimise the use of biological DMARDs in inflammatory arthritis during pregnancy.
AB - Active inflammatory arthritis in pregnancy is associated with an increased risk of adverse pregnancy outcomes. Treatment of active inflammation and maintenance of low disease activity with medication reduces these risks. Therapeutic decisions on disease-modifying antirheumatic drugs (DMARDs) in pregnancy are complicated by safety concerns, which have led to inappropriate withdrawal of treatment and consequential harm to mother and fetus. Studies of inflammatory arthritis in pregnancy have consistently shown minimal safety concerns with the use of biological DMARDs and an increased risk of disease flare with discontinuation of biological DMARDs. It is our opinion that during pregnancy, the benefits of disease control with biological DMARDs, when required in addition to conventional synthetic DMARDs, outweigh the risks. In this Series paper, we review the reasons for reconsideration of equipoise and propose an agenda for future research to optimise the use of biological DMARDs in inflammatory arthritis during pregnancy.
UR - http://www.scopus.com/inward/record.url?scp=85197035364&partnerID=8YFLogxK
U2 - 10.1016/S2665-9913(24)00097-3
DO - 10.1016/S2665-9913(24)00097-3
M3 - Review article
AN - SCOPUS:85197035364
SN - 2665-9913
VL - 6
SP - e546-e559
JO - The Lancet Rheumatology
JF - The Lancet Rheumatology
IS - 8
ER -