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Catch me if you can: a national survey of rheumatologists and obstetricians on the use of DMARDs during pregnancy

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Abstract

The use of disease-modifying anti-rheumatic drugs and biological therapy is variable throughout pregnancy. This questionnaire-based study was undertaken to explore and compare the current practice amongst rheumatologists and obstetricians across the UK, regarding the use of drugs during pregnancy. A questionnaire was devised to address issues regarding individual drugs used during preconception, pregnancy and lactation. Members of the British Society of Rheumatology, Midlands Rheumatology Society and the British Maternal Fetal Medicine Society were emailed. Results were analysed by the online survey software and Fisher’s exact testing. Our results show differences between rheumatologists and obstetricians. A total of 500 members of each society were emailed. There were 102 (20 %) versus 33 (7 %) respondents. With regard to medication, in relation to advice given before conception, hydroxychloroquine 80 versus 61 % continue, 19 versus 15 % discontinue (p = 1.0); sulphasalazine 59 versus 70 % continue, 41 versus 6 % discontinue (p = 0.002); azathioprine 62 versus 58 % continue, 36 versus 21 % discontinue (p = 0.37); methotrexate 0 versus 3 % continue, 100 versus 76 % discontinue (p = 0.2); leflunomide 0 versus 0 % continue, 98 versus 42 % discontinue (p = 1.0); anti-TNF therapy 7 versus 15 % continue, 54 versus 54 % discontinue (p = 0.05); and rituximab 2 versus 12 % continue, 95 versus 52 % (p = 0.01) would discontinue prior to conception. This survey is the first of its nature amongst rheumatologists and obstetricians. Most would give advice to continue with sulphasalazine, azathioprine and stop methotrexate and leflunomide. We observed no uniform practice and therefore recommend guidelines.

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References

  1. Burkowitz RL, Cousten DR, Mochizuki TK (1981) Handbook for prescribing medications during pregnancy. Muston, Massachusetts

    Google Scholar 

  2. WHO document (1985) Drugs in pregnancy & delivery. Report of the 13th European Symposium on clinical pharmacological evaluation in drug control, Schlangenbad

  3. Kay A (1985) Anti-rheumatic drugs in pregnancy and lactation. Br J Rheumatol 24:230–231

    Article  PubMed  CAS  Google Scholar 

  4. Ostensen M, Khamashta M, Lockshin M et al (2006) Anti-inflammatory and immunosuppressive drugs in reproduction. Arthritis Res Ther 8:209–228. doi:10.1186/ar1957

    Article  PubMed  Google Scholar 

  5. Ostensen M, Lockshin M, Doria A et al (2008) Update on safety during pregnancy of biological agents and some immunosuppressive anti-rheumatic drugs. Rheumatology 47(suppl 3):iii28–iii31. doi:10.1093/rheumatology/ken168

    Google Scholar 

  6. de Man YA, Dolhain RJ, van de Geijn FE et al (2008) Disease activity of rheumatoid arthritis during pregnancy: results from a nationwide perspective study. Arthritis Rheum 59:1241–1248

    Article  PubMed  Google Scholar 

  7. Barrett JH, Brennan P, Fiddler M, Silman AJ (1999) Does rheumatoid arthritis remit during pregnancy and relapse post partum? Results from a nationwide study in the United Kingdom performed prospectively from late pregnancy. Arthritis Rheum 42:1219–1227

    Article  PubMed  CAS  Google Scholar 

  8. Ostensen M, Forger F (2009) Management of RA medications in pregnant patients. Nat Rev Rheumatol 5:382–390. doi:10.1038/nrrheum.2009.103

    Article  PubMed  Google Scholar 

  9. Gayed M, Gordon C (2007) Drugs in rheumatic disease during pregnancy. In: Reuben P, Ramsey M (eds) Prescribing & pregnancy, 4th edn. Blackwell Publishing, London, pp 98–113

    Chapter  Google Scholar 

  10. Jain V, Gordon C (2011) Managing pregnancy in inflammatory rheumatological diseases. Arthritis Res Ther 13:206. doi:10.1186/ar3227

    Article  PubMed  Google Scholar 

  11. Buchanan NM et al (1996) Hydroxychloroquine in lupus pregnancy: review of a series of 36 cases. Ann Rheum Dis 55:486–488

    Article  PubMed  CAS  Google Scholar 

  12. Clowse MEB et al (2006) Hydroxychloroquine in lupus pregnancy. Arthritis Rheum 54:3640–3647

    Article  PubMed  Google Scholar 

  13. Costedoat-Chalumeau N et al (2003) Safety of hydroxychloroquine in pregnant patients with connective tissue diseases: a study of 133 cases compared with a control group. Arthritis Rheum 48:3207–3211

    Article  PubMed  CAS  Google Scholar 

  14. Moskovitz DN et al (2004) The effect on the foetus of medications used to treat pregnant inflammatory bowel disease patients. Am J Gastroenterol 99:656–661

    Article  PubMed  Google Scholar 

  15. Norgard B (2001) Population based case control study of the safety of sulphasalazine used during pregnancy. Aliment Pharmacol Ther 15:483–486

    Article  PubMed  CAS  Google Scholar 

  16. Mogadam M et al (1981) Pregnancy in inflammatory bowel disease: effect of sulphasalazine and corticosteroids on fetal outcome. Gastroenterology 80:72–76

    PubMed  CAS  Google Scholar 

  17. Goldstein LH et al (2007) Pregnancy outcome of women exposed to azathioprine during pregnancy. Birth defects research. Clin Mol Teratol 79:696–701

    Article  CAS  Google Scholar 

  18. Ostensen M et al (2000) Low dose weekly methotrexate in early pregnancy. A case series and review of the literature. J Rheumatol 27:1872–1875

    PubMed  CAS  Google Scholar 

  19. Feldkamp M, Carey JC (1993) Clinical teratology counselling and consultation case report: low dose methotrexate exposure in early weeks of pregnancy. Teratology 47:533–539

    Article  PubMed  CAS  Google Scholar 

  20. Brent RL (2001) Teratogen update: reproductive risks of leflunomide (Arava), a pyrimidine synthesis inhibitor: counselling women taking leflunomide before or during pregnancy and men taking leflunomide while contemplating fathering a child. Teratology 63:106–112

    Article  PubMed  CAS  Google Scholar 

  21. Chambers CD et al (2004) Pregnancy outcome following early gestational exposure to leflunomide: the OTIS rheumatoid arthritis in pregnancy study [abstract 251]. Pharmacoepidemiol Drug Saf 13(supplement):S126

    Google Scholar 

  22. Orencia (abatacept; lyophilized powder for intravenous infusion) package insert (Bristol-Myers, 2008)

  23. Rituxan (rituximab; iron dextran injection) package insert (Genentech, 2008)

  24. Roux CH et al (2007) Pregnancy in rheumatology patients exposed to anti tumour necrosis factor (TNF)-alpha therapy. Rheumatology 46:695–698. doi:10.1093/rheumatology/kel400

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors would like to thank the British Society of Rheumatology, British Fetal and Maternal Society and Midlands Rheumatology Society for distribution of the survey to its members.

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The authors have declared no conflicts of interest.

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Correspondence to Sonia Panchal.

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Panchal, S., Khare, M., Moorthy, A. et al. Catch me if you can: a national survey of rheumatologists and obstetricians on the use of DMARDs during pregnancy. Rheumatol Int 33, 347–353 (2013). https://doi.org/10.1007/s00296-012-2418-0

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  • DOI: https://doi.org/10.1007/s00296-012-2418-0

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