Stopping bDMARDs at the beginning of pregnancy is associated with disease flares and preterm delivery in women with rheumatoid arthritis
Objectives: Women with Rheumatoid Arthritis (RA) can experience flares during pregnancy that might influence pregnancy outcomes. We aimed at assessing the disease course during pregnancy and identifying risk factors for flares.Methods: Data about prospectively-followed pregnancies in RA were retrosp...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2022.887462/full |
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| author | Maria Chiara Gerardi Francesca Crisafulli Antía García-Fernandez Daniele Lini Chiara Bazzani Ilaria Cavazzana Matteo Filippini Micaela Fredi Roberto Gorla Maria Grazia Lazzaroni Cecilia Nalli Marco Taglietti Andrea Lojacono Francesca Ramazzotto Cristina Zanardini Sonia Zatti Franco Franceschini Angela Tincani Laura Andreoli |
| author_facet | Maria Chiara Gerardi Francesca Crisafulli Antía García-Fernandez Daniele Lini Chiara Bazzani Ilaria Cavazzana Matteo Filippini Micaela Fredi Roberto Gorla Maria Grazia Lazzaroni Cecilia Nalli Marco Taglietti Andrea Lojacono Francesca Ramazzotto Cristina Zanardini Sonia Zatti Franco Franceschini Angela Tincani Laura Andreoli |
| author_sort | Maria Chiara Gerardi |
| collection | DOAJ |
| description | Objectives: Women with Rheumatoid Arthritis (RA) can experience flares during pregnancy that might influence pregnancy outcomes. We aimed at assessing the disease course during pregnancy and identifying risk factors for flares.Methods: Data about prospectively-followed pregnancies in RA were retrospectively collected before conception, during each trimester and in the post-partum period. Clinical characteristics, disease activity (DAS28-CRP3), medication use, and pregnancy outcomes were analysed with regard to disease flares.Results: Among 73 women who had a live birth, 64 (88%) were in remission/low disease activity before conception. During pregnancy, a flare occurred in 27 (37%) patients, mainly during first and second trimester. Flares during pregnancy were associated with the discontinuation of bDMARDs at positive pregnancy test (55% of patients with flare vs. 30% of patients with no flare, p 0.034, OR 2.857, 95% CI 1.112–8.323) and a previous use of >1 bDMARDs (33% of patients with flare vs. 10% of patients with no flare, p 0.019, OR 4.1, 95%CI 1.204–13.966). Preterm pregnancies were characterised by higher values of CRP [10 mg/L (5–11) vs. 3 mg/L (2.5–5), p 0.01] and DAS28-CRP3 [4.2 (1.9–4.5) vs. 1.9 (1.7–2.6), p 0.01] during the first trimester as compared with pregnancies at term. Preterm delivery was associated with the occurrence of flare during pregnancy (flare 27% vs. no-flare 7%, p 0.034, OR 4.625, 95%CI 1.027–20.829).Conclusion: Preterm delivery in RA patients was associated with flares during pregnancy. Flares occurred more frequently after the discontinuation of bDMARDs at positive pregnancy test. Women with aggressive RA on treatment with bDMARDs should be considered as candidates for continuing bDMARDs during pregnancy in order to reduce the risk of flare and adverse pregnancy outcomes. |
| first_indexed | 2024-04-12T07:58:03Z |
| format | Article |
| id | doaj.art-c1f926b339de4194a3b52acb10f7d464 |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-04-12T07:58:03Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-c1f926b339de4194a3b52acb10f7d4642022-12-22T03:41:25ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122022-08-011310.3389/fphar.2022.887462887462Stopping bDMARDs at the beginning of pregnancy is associated with disease flares and preterm delivery in women with rheumatoid arthritisMaria Chiara Gerardi0Francesca Crisafulli1Antía García-Fernandez2Daniele Lini3Chiara Bazzani4Ilaria Cavazzana5Matteo Filippini6Micaela Fredi7Roberto Gorla8Maria Grazia Lazzaroni9Cecilia Nalli10Marco Taglietti11Andrea Lojacono12Francesca Ramazzotto13Cristina Zanardini14Sonia Zatti15Franco Franceschini16Angela Tincani17Laura Andreoli18Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyDepartment of Rheumatol, University Hospital Ramón y Cajal, Madrid, SpainRheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyObstetrics and Gynaecology Unit, ASST Garda Ospedale of Desenzano, Desenzano del Garda, ItalyObstetrics and Gynaecology, ASST Spedali Civili, Brescia, ItalyObstetrics and Gynaecology, ASST Spedali Civili, Brescia, ItalyObstetrics and Gynaecology, ASST Spedali Civili, Brescia, ItalyRheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyObjectives: Women with Rheumatoid Arthritis (RA) can experience flares during pregnancy that might influence pregnancy outcomes. We aimed at assessing the disease course during pregnancy and identifying risk factors for flares.Methods: Data about prospectively-followed pregnancies in RA were retrospectively collected before conception, during each trimester and in the post-partum period. Clinical characteristics, disease activity (DAS28-CRP3), medication use, and pregnancy outcomes were analysed with regard to disease flares.Results: Among 73 women who had a live birth, 64 (88%) were in remission/low disease activity before conception. During pregnancy, a flare occurred in 27 (37%) patients, mainly during first and second trimester. Flares during pregnancy were associated with the discontinuation of bDMARDs at positive pregnancy test (55% of patients with flare vs. 30% of patients with no flare, p 0.034, OR 2.857, 95% CI 1.112–8.323) and a previous use of >1 bDMARDs (33% of patients with flare vs. 10% of patients with no flare, p 0.019, OR 4.1, 95%CI 1.204–13.966). Preterm pregnancies were characterised by higher values of CRP [10 mg/L (5–11) vs. 3 mg/L (2.5–5), p 0.01] and DAS28-CRP3 [4.2 (1.9–4.5) vs. 1.9 (1.7–2.6), p 0.01] during the first trimester as compared with pregnancies at term. Preterm delivery was associated with the occurrence of flare during pregnancy (flare 27% vs. no-flare 7%, p 0.034, OR 4.625, 95%CI 1.027–20.829).Conclusion: Preterm delivery in RA patients was associated with flares during pregnancy. Flares occurred more frequently after the discontinuation of bDMARDs at positive pregnancy test. Women with aggressive RA on treatment with bDMARDs should be considered as candidates for continuing bDMARDs during pregnancy in order to reduce the risk of flare and adverse pregnancy outcomes.https://www.frontiersin.org/articles/10.3389/fphar.2022.887462/fullrheumatoid arthritispregnancybDMARDsTNF inhibitorsdisease activitydisease flare |
| spellingShingle | Maria Chiara Gerardi Francesca Crisafulli Antía García-Fernandez Daniele Lini Chiara Bazzani Ilaria Cavazzana Matteo Filippini Micaela Fredi Roberto Gorla Maria Grazia Lazzaroni Cecilia Nalli Marco Taglietti Andrea Lojacono Francesca Ramazzotto Cristina Zanardini Sonia Zatti Franco Franceschini Angela Tincani Laura Andreoli Stopping bDMARDs at the beginning of pregnancy is associated with disease flares and preterm delivery in women with rheumatoid arthritis Frontiers in Pharmacology rheumatoid arthritis pregnancy bDMARDs TNF inhibitors disease activity disease flare |
| title | Stopping bDMARDs at the beginning of pregnancy is associated with disease flares and preterm delivery in women with rheumatoid arthritis |
| title_full | Stopping bDMARDs at the beginning of pregnancy is associated with disease flares and preterm delivery in women with rheumatoid arthritis |
| title_fullStr | Stopping bDMARDs at the beginning of pregnancy is associated with disease flares and preterm delivery in women with rheumatoid arthritis |
| title_full_unstemmed | Stopping bDMARDs at the beginning of pregnancy is associated with disease flares and preterm delivery in women with rheumatoid arthritis |
| title_short | Stopping bDMARDs at the beginning of pregnancy is associated with disease flares and preterm delivery in women with rheumatoid arthritis |
| title_sort | stopping bdmards at the beginning of pregnancy is associated with disease flares and preterm delivery in women with rheumatoid arthritis |
| topic | rheumatoid arthritis pregnancy bDMARDs TNF inhibitors disease activity disease flare |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2022.887462/full |
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