Journal
ARTHRITIS & RHEUMATOLOGY
Volume 71, Issue 6, Pages 901-907Publisher
WILEY
DOI: 10.1002/art.40821
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Funding
- AbbVie
- Amgen
- Apotex
- Barr Laboratories
- Bristol-Myers Squibb
- Celgene
- Janssen Pharmaceuticals
- Kali Laboratories
- Pfizer
- Hoffman La Roche-Genentech
- Sandoz Pharmaceuticals
- Genzyme Sanofi-Aventis
- Takeda Pharmaceutical Company Limited
- Teva Pharmaceutical Industries
- UCB
- Seqirus
- Regeneron
- GlaxoSmithKline
- AstraZeneca Medimmune
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ObjectiveTo investigate whether the discontinuation of tumor necrosis factor inhibitors (TNFi) during pregnancy is associated with any changes of the disease course in women with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). MethodsPregnant women with RA and JIA from the US and Canada were enrolled in the Organization of Teratology Information Specialists (OTIS) Autoimmune Diseases in Pregnancy Project, a prospective cohort study. Information about medication and disease activity (patient-reported outcome measures) was collected prior to gestational week 20 and at gestational week 32. Associations between patterns of TNFi continuation or discontinuation and disease activity changes were tested in unadjusted and multivariate analyses. ResultsAmong 490 women (397 with RA, 93 with JIA) enrolled between 2005 and 2017, 122 (24.9%) discontinued a TNFi before gestational week 20, 201 (41.0%) received a TNFi beyond week 20, and 167 (34.1%) did not receive a TNFi during pregnancy. At the time of enrollment, disease activity was low to minimal in 72.9% of women. TNFi discontinuation was not associated with a clinically important worsening of patient reported outcome measures at the third trimester. Univariate but not multivariate analysis showed that women receiving TNFi beyond week 20 were more likely to experience improved disease activity scores at the third trimester. ConclusionDiscontinuing TNFi before gestational week 20 seems feasible in women with RA and JIA who enter pregnancy with well-controlled disease.
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