No Change in Disease Activity When Pregnant Arthritis Patients Stop TNFi

A recent study published in Arthritis & Rheumatology found that pregnant women with rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA) whose disease is well-controlled can safely discontinue the use of tumor necrosis factor inhibitors (TNFi) before gestational week 20.

Researchers assessed 490 women with RA (n = 397) or JIA (n = 93) who were enrolled in the Organization of Teratology Information Specialists (OTIS) Autoimmune Diseases in Pregnancy Project, a prospective cohort study, between 2005 and 2017. Details about medication and patient-reported outcome measures (PROMs) regarding disease activity were gathered before week 20 and at gestational week 32.

Enrollment disease activity levels were low to minimal in most (72.9%) patients. Of the total cohort, 34.1% (n = 167) did not use a TNFi during pregnancy. Nearly a quarter (n = 122, 24.9%) of women discontinued a TNFi before week 20, and the remaining 41% (n = 201) used a TNFi past week 20. Ceasing TNFi use did not significantly worsen PROMs at the third trimester. Univariate analysis revealed that the TNFi past week 20 patients had improved disease activity scores during their final trimester, but multivariate analysis did not yield this outcome.

One of the study’s limitations was that because there were so few patients in the JIA cohort, researchers could not separately evaluate outcomes for those with JIA versus RA. The researchers also noted that because disease activity was so low in most of the patients, these women may have found symptom relief during the third trimester anyway, regardless of TNFi status.

“In this context, the ameliorating effect of pregnancy on RA and JIA, which is most pronounced in the third trimester, may play a role,” they wrote.

American College of Rheumatology and National Psoriasis Foundation Issue Joint PsA Guidelines

Low Persistence Rates in Rheumatoid Arthritis Patients Treated with Triple Therapy are Attributed to Adverse Drug Events Associated with Sulfasalazine

Tumor Necrosis Factor Inhibitors and Cancer Recurrence in Patients With Rheumatoid Arthritis

Juvenile Arthritis Patients Distinct From Those With RA

Sources: Rheumatology News, Arthritis & Rheumatology