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Background: Treat to target is a goal in pregnant women with spondyloarthristis. There is increasing evidence on safe use with TNF inhibitors during pregnancy (1). Adjusted use of TNF inhibitors preconception and throughout pregnancy may stabilize disease activity and prevent flares (2). Low disease activity is also beneficial for the fetus.
Objectives: To study the use of TNF-inhibitors among women with spondyloarthritis in Norway before, during and after pregnancy.
Methods: RevNatus is a Norwegian, nationwide quality register that monitors treatment of inflammatory rheumatic diseases before, during and after pregnancy. Data from RevNatus in the period October 2017 to October 2019 were used to map the use of all types of TNF inhibitors among 208 women with spondyloarthitis, fulfilling the ASAS criteria.
The use of medication was reported at the time of visit in outpatient clinic. The frequency of use of TNF inhibitors is registered at seven timepoints from pre-pregnancy to twelve months after delivery.
Results: The use of TNF-inhibitors was reported at each visit for all the women with spondyloarthritis. Most women are not using TNF inhibitors before and beyond conception. Most of the women continuing TNF inhibitors beyond conception, used certolizumab, etanercept, or adalimumab. Infliximab or golimumab were not used in pregnancy (tabell 2).
| SPA | Certoli-zumab | Etaner-cept | Adali-mumab | Golim-umab | Inflik-simab | No TNF -inhibitor |
|---|---|---|---|---|---|---|
| Before Pregnancy
| 10% (14) | 8% (11) | 6% (9) | 6% (9) | 69% (96) | |
| 1.trimester
| 7% (7) | 7% (7) | 2 % (2) | 84% (86) | ||
| 2.trimester
| 7% (7) | 6% (6) | 1% (1) | 87% (90) | ||
| 3. trimester
| 3% (3) | 2% (2) | 1% (1) | 94% (89) | ||
| 6 weeks post partum
| 15% (15) | 10% (10) | 8% (8) | 3% (3) | 64% (64) | |
| 6 months post partum
| 19% (16) | 12% (10) | 7% (6) | 2% (2) | 2% (2) | 55% (46) |
| 12 months post partum
| 22% (16) | 15% (11) | 7% (5) | 4% (3) | 5% (4) | 47% (35) |
Conclusion: A majority of the women with spondyloarthritis were not treated with TNF inhibitors before or during pregnancy. Only a few of the women with spondylosthritis continued treatment with TNF inhibitors during pregnancy.
REFERENCES:
[1]Gotestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. 2016;75(5):795-810.
[2]van den Brandt S, Zbinden A, Baeten D, Villiger PM, Ostensen M, Forger F. Risk factors for flare and treatment of disease flares during pregnancy in rheumatoid arthritis and axial spondyloarthritis patients. Arthritis Res Ther. 2017;19(1):64.
Disclosure of Interests: None declared