An in-depth article from Expert Review of Clinical Immunology published on Medscape.com examines the issue of anti-TNF therapy and pregnancy outcomes in women with inflammatory arthritis.

The article examines current information from cases of animal pregnancy, changes in disease activity in women with inflammatory arthritis who are pregnant, the chemical changes that take place in the body in regards to pregnancy and inflammatory arthritis and known cases where women who are pregnant who have continued taking a TNF-a Inhibitor.

The article cites a recent survey in which, "Fewer than half of the rheumatologists surveyed agreed that pregnancy is contraindicated with the use of these medications (38.6% for etanercept and 46.5% infliximab). Almost half stated that they were uncertain about pregnancy safety with the use of these agents (49.7% for etanercept and 45.4% for infliximab). Despite this uncertainty, respondents generally recommended effective methods of contraception when prescribing these agents to their female patients (75.4% for etanercept and 73.4% for infliximab). However, markedly fewer were likely to review ongoing contraception with women treated with etanercept or infliximab (41.7 and 43.8%, respectively)."

In the "Expert Commentary" section of the article, the authors state, "Current available data do not seem to support a large excess risk of adverse pregnancy and/or fetal outcomes in women exposed to anti-TNF therapy at some point during pregnancy. However, evidence is limited by the relatively small number of published case series and case reports, differences in the type and dosage of anti-TNF agents, possible use of concomitant teratogenic drugs (e.g., methotrexate and leflunomide) and the timing of exposure during pregnancy."

They go on to state that, "Considering this uncertainty, it is clear that each woman requiring disease-modifying drugs during her pregnancy must be evaluated individually. In cases without a therapeutic alternative, anti-TNF therapy has been used in the first trimester of pregnancy. However, during the late second or third trimester, more caution is advised since placental transfer, with therapeutic levels in the newborn, has been documented. Furthermore, in women requiring disease control during the period of attempted conception, which can be prolonged, anti-TNF agents are probably one of the best therapeutic options when compared with other DMARDs, such as methotrexate and leflunomide, which must be stopped several months prior to conception. Finally, the toxicity of anti-TNF therapy exposure during lactation is theoretically negligible since these agents are likely to be digested in the GI tract of the infant. However, in all situations, it is imperative to provide appropriate information to the patient and family (including admission of what remains unknown), so that the potential risks and benefits can be weighed."

For more information on pregnancy and inflammatory arthritis here on spondylitis.org, please click here.

To read the article in its entirety at medscape.com, please click here. (Note that Medscape sometimes requires free membership to read articles).

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