Autoimmune connective tissue diseases

Tocilizumab use in pregnancy: Analysis of a global safety database including data from clinical trials and post-marketing data

“…This confirms observations in other pregnancy outcome studies in women with RA [23;24]. Whereas pregnancy outcomes in patients with well-controlled/stable RA are comparable to those in the general population, high disease activity increases the risk of preterm birth and low birth weight [25][26][27][28]. A prospective study of 440 pregnancies with rheumatoid arthritis found high disease activity predictive for preterm birth and low birth weight [29].…”

Management of systemic lupus erythematosus during pregnancy: challenges and solutions

“…Stratification of women into these three groups enables an overall approach to management, with adjustment(s) for individual situations:8,9 SLE in remission, or stable low disease activity: medication should be reviewed and adjusted as necessary; those women should be advised that it is safe to plan a pregnancy.SLE at an early stage following recent diagnosis, or active disease: those women should be encouraged to postpone pregnancy and use effective contraception; medication should be reviewed with prescription of immunosuppressives (ideally hydroxychloroquine [HCQ] and/or azathioprine which will be safe in pregnancy); further review(s) should be done to monitor progress; once SLE condition improves (or ideally, enters remission), the women should be advised that it is safe to plan a pregnancy.Severe impairment of organ function and/or preexisting severe organ damage (Table 2): those women should be advised about the serious risks to health and pregnancy-related risks; pregnancy should be discouraged; alternatives, including adoption and surrogacy (own or donor eggs), should be discussed.…”

“…Women with anti-Ro and/or anti-La antibodies should be counseled about the risks of fetal–neonatal CHB and/or NLE (Table 3). 9,14,15…”

“…Details of medications and safety information are provided in Table 4: anti-inflammatories and analgesics, corticosteroids (non-fluorinated), and immunosuppressants (including anti-malarials) 8,9,31–35…”

“…Medications which are safe throughout pregnancy (all trimesters) and during lactation to maintain remission and/or treat flare are HCQ, azathioprine, cyclosporine, and tacrolimus 9,30. The aim should be to use steroid-sparing immunosuppressants (such as azathioprine) with ideally no steroids or else the lowest effective maintenance dose (ideally <7.5 mg prednisolone per day) 9,30.…”