In pregnant women with rheumatoid arthritis (RA), the use of a modern treatment approach is associated with low disease activity (LDA) and remission, according to study results published in Annals of the Rheumatic Diseases.
Previous research has shown that in patients with RA, high disease activity is associated with a prolonged time to pregnancy and is an independent risk factor for lower birth weight.
In the current study, the researchers sought to establish the feasibility of a modern treatment approach, including treat-to-target (T2T) and the prescription of tumor necrosis factor (TNF) inhibitors, among women with RA who wish to conceive or are pregnant.
The current study was conducted among patients in the Preconception Counseling in Active RA (PreCARA; ClinicalTrials.gov Identifier: NCT01345071) cohort, an ongoing, prospective cohort study on inflammatory rheumatic diseases and pregnancy. Available data up to October 2020 were used. Patients with RA who delivered their baby and who had 1 or more postpartum visits were included in the study.
Study participants received treatment according to a modified T2T approach, in which the obvious restrictions associated with pregnancy were considered. Results from the PreCARA study were compared to those from the Pregnancy-Induced Amelioration of Rheumatoid Arthritis (PARA) study, a historic reference cohort on RA during pregnancy. All women in the PARA cohort received treatment based on the existing standards between 2002 and 2010. These women were preferably enrolled in the cohort before becoming pregnant. Study visits were scheduled every 3 months before conception; during each trimester; and at 6, 12, and 26 weeks postpartum.
A total of 309 women with RA were included in the PreCARA study, to whom a total of 188 children were born. Overall, 87 (47.3%) women in the PreCARA cohort received a TNF inhibitor at any time during their pregnancy.
Results of the study showed that mean disease activity over time was significantly lower in the PreCARA cohort compared with the PARA cohort (P <.001). In addition, mean disease activity at every timepoint in the PreCARA cohort was statistically lower than in the reference cohort (P <.001).
In the PreCARA group, 75.4% of the study participants were in LDA or remission prior to becoming pregnant, which increased to 90.4% in their third trimester. In contrast, these percentages were 33.2% and 47.3%, respectively, in the PARA group. In fact, the percentage of women in remission or LDA at all timepoints during follow-up was significantly higher in the PreCARA cohort compared with the PARA cohort (P <.001).
Study limitations included the differences in patient characteristics between the 2 cohorts; the possibility of selection bias; and the inability to prove that T2T or TNF inhibitor therapy were responsible for improved disease outcomes during pregnancy.
Researchers concluded that the effect of a modern treatment approach on fertility outcomes and pregnancy outcomes in women with RA should be the focus of additional studies. They added, “…LDA or remission should also be strived for in this group of patients, despite the obvious restrictions on medication use during pregnancy.”
Smeele HTW, Röder E, Wintjes HM, Kranenburg-van Koppen LJ, Hazes JM, Dolhain RJ. Modern treatment approach results in low disease activity in 90% of pregnant rheumatoid arthritis patients: the PreCARA study. Ann Rheum Dis. Published online February 10, 2021. doi:10.1136/annrheumdis-2020-219547