Pregnant women with rheumatoid arthritis (RA) were found to regularly discontinue medications often considered appropriate for use during pregnancy, according to results from a study published in Rheumatology.
In a retrospective manner, researchers identified 1301 pregnant women with RA who had a delivery between January 2002 and December 2012. Clinical data, including patient demographics, laboratory and diagnostic information, and vital statistics were collected from the Population Data BC repository located in British Columbia, Canada. Among participants, current and discontinued drug use was examined before, during, and after pregnancy. In the analysis, the main RA-specific medications included conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), glucocorticosteroids and nonsteroidal anti-inflammatory drugs, and biologics.
After analysis, the researchers found considerable drug discontinuation among the cohort, especially in the first trimester. In particular, sulfasalazine, biologics, antimalarials, and azathioprine were discontinued in 69.5%, 50.8%, 57.3%, and 59.1% of patients, respectively.
In addition, the number of rheumatology visits (odds ratio [OR], 0.86; 95% CI, 0.75-0.97) and maternal age (OR, 0.90; 95% CI, 0.86-0.95) were inversely associated with the cessation of antimalarial drugs in the first trimester. The same association was seen with previous adverse birth outcome for biologic medications (OR, 0.22; 95% CI, 0.05-0.95).
The primary limitation of the study was the dependence on the use of administrative data.
“Education about medication-taking during pregnancy is needed to better support decisions among women with RA,” the authors concluded.
Rebić N, Sayre EC, Zusman EZ, Amiri N, Baldwin C, De Vera MA. Perinatal use and discontinuation of disease-modifying anti-rheumatic drugs and biologics in women with rheumatoid arthritis: a cohort study [published online October 18, 2019]. Rheumatology. doi:10.1093/rheumatology/kez478