Rheumatology Advance Access originally published online on August 6, 2007
Rheumatology 2007 46(9):1508; doi:10.1093/rheumatology/kem068
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Pregnancy in rheumatology patients exposed to anti-tumour necrosis factor (TNF)-
therapy
Department of Rheumatology, Bnai Zion Medical Center/Faculty of Medicine, Technion, Haifa, Israel and 1Department of Internal Medicine, Carmel Medical Center, Haifa, Israel
Correspondence to: I. Rosner. E-mail: rosneri{at}tx.technion.ac.il
SIR, We read with great interest the report by Roux and associates [1] and feel it may be of interest to report our experience, which supports and extends their findings. In our clinic, with 250 women receiving anti-tumour necrosis factor (TNF)-
agents in the years 2002–2006, four women with severe intractable arthritis successfully conceived and maintained their pregnancies to full term while under continuous anti-TNF- therapy.
Patient A, with seronegative erosive juvenile idiopathic arthritis since age 14 was receiving infliximab and methotrexate (MTX) to control her arthritis. Twelve years earlier she had given birth after in vitro fertilization (IVF) therapy, and at age 36 she was most desirous of another child. MTX was switched to azathioprine and, while under infliximab treatment, again with IVF, she became pregnant. Under continuous therapy, at 34.5 weeks gestation, due to premature rupture of membranes, she delivered a healthy child by Caesarean section. Patient B, a 30-yr-old nulliparous woman with rheumatoid arthritis (RA) and hypothyroidism had received infliximab and azathioprine for 2 yrs prior to becoming pregnant, while still on the drug regimen. She continued therapy until she delivered a fully healthy child at week 39. Patient C, a 27-yr-old woman with severe polyarthritis since age 17, with serologies consistent with lupus (‘rhufus’), conceived spontaneously after two failed IVF pregnancies while under etanercept–mycophenolate fenatyl treatment. Treatment was continued throughout the uneventful pregnancy until Caesarean section, due to premature rupture of membranes, at week 37. Patient D, a 40-yr-old woman with erosive RA, and one 17-yr-old daughter, became pregnant after many years of failure to conceive, while under infliximab and azathioprine treatment. Treatment was continued until she delivered a healthy child at 40 weeks gestation. For all four women, these were important pregnancies and intensive consultations on the uncertainty of anti-TNF- agent effects on pregnancy were conducted before they became pregnant. With onset under anti-TNF- therapy, these pregnancies were not ‘accidental’ but were highly sought, and in all cases, treatment was continued throughout pregnancy with close monitoring. In all cases, the newborn babies were entirely well and remain so—with 6 months to 2 yrs follow-up.
While most of the reports to date on anti-TNF- agents and pregnancy have focused on inflammatory bowel disease, at least ongoing two registries in rheumatic disease patients suggest their apparent safety [2, 3]. We believe that properly selected and properly monitored women in whom these drugs are essential to control of their arthritis and yet desire to have children can be encouraged to proceed, with caution, on the basis of the currently available data.
The authors have declared no conflicts of interest.
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- Roux CH, Brocq O, Breuil V, Albert C, Euller-Ziegler L. Pregnancy in rheumatology patients exposed to anti-tumour necrosis factor (TNF)- therapy. Rheumatology (2006) Dec 7. [Epub ahead of print].
- Chambers CD, Johnson DL, Jones KL. Pregnancy outcome in women exposed to anti-TNF alpha medications: the OTIS rheumatoid arthritis in Pregnancy Study. Arthritis Rheum (2004) 50:S479.
- Hyrich KL, Watson KD, Dixon WG, Silman AJ, Symmons DPM. Pregnancy experience in women with rheumatic diseases exposed to biologic agents: results from the BSR biologic register. Ann Rheum Dis (2006) 65(Suppl 2):321.
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