Editorial: Safety of Tumor Necrosis Factor Inhibitors in Pregnancy

Progression of Bone and Joint Destruction During the Perinatal Period in Patients With Rheumatoid Arthritis and Juvenile Idiopathic Arthritis in the Last Decade

“…Withdrawal of antirheumatic drugs in patients with RA and JIA can lead to recurrence of disease activities [ 3 , 4 , 7 , 9 , 11 ]. In addition, if the disease is active during pregnancy, it may not only progress to joint destruction but also adversely affect pregnancy and pregnancy continuation [ 7 , 10 ]. High disease activity during gestation has been reported as a risk factor for preterm birth.…”

“…Of these drugs, methotrexate (MTX) is associated with increased miscarriage, fetal death and teratogenicity; nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported to have a risk of pulmonary hypertension due to early arterial canal closure, and leflunomide and mizoribine have been reported to have a risk of teratogenicity [ 2 , 3 , 7 - 9 ]. However, withdrawal of antirheumatic drugs for patients with RA leads to worse disease activity [ 7 , 10 ]. When the disease activity of RA is active during pregnancy, it may adversely affect pregnancy complications and continuity of pregnancy and cause bone and joint destruction by severe arthritis [ 3 , 4 , 9 ].…”

“…The European Alliance of Associations for Rheumatology (EULAR) recommendation for the use of antirheumatic drugs in pregnancy published in 2016 indicates that hydroxychloroquine, salazosulfapyridine (SASP), azathioprine, cyclosporine, tacrolimus (TAC), and colchicine are safe for pregnant women with RA. It is recommended to continue these drugs during pregnancy to maintain remission [ 3 , 4 , 9 , 10 ].…”

“…In Japan, the expert committee of the Ministry of Health Labor and Welfare published guidelines in 2018, indicating that SASP, TAC, mercaptopurine, hydroxychloroquine, and antibody preparations are not teratogenic at present and can be administered to a pregnant woman with rheumatic disease [ 9 ]. In addition, reports of the safety and effectiveness of tumor necrosis factor (TNF) inhibitors during pregnancy have increased in the last decade [ 7 , 10 , 11 ].…”

More Comprehensive Considerations in Assessing the Safety of Treatments During Pregnancy: Comment on the Editorial by Pope

“…I read with interest a recent editorial by Dr. Pope reflecting on the hurdles in evaluating drug safety during pregnancy . In the same issue of Arthritis & Rheumatology , Clowse et al discussed updated data from a prospective follow‐up of pregnant women exposed to certolizumab pegol (CZP) .…”