The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation

Carina Götestam Skorpen, Maria Hoeltzenbein, Angela Tincani, Rebecca Fischer-Betz, Elisabeth Elefant, Christina Chambers, Josè Da Silva, Catherine Nelson-Piercy, Irene Cetin, Nathalie Costedoat-Chalumeau, Radboud Dolhain, Frauke Förger, Munther Khamashta, Guillermo Ruiz-Irastorza, Angela Zink, Jiri Vencovsky, Maurizio Cutolo, Nele Caeyers, Claudia Zumbühl, Monika Østensen*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

800 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)795-810
Number of pages16
JournalAnnals of the Rheumatic Diseases
Volume75
Issue number5
Early online date17 Feb 2016
DOIs
Publication statusPublished - 1 May 2016

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