Giles, Ian;
Thorne, Iona;
Schmidt, Nanna Surlemont;
Reid, Claire;
Crossley, Amy;
Panca, Monica;
Freemantle, Nick;
... Clowse, Megan EB; + view all
(2024)
The time of equipoise on the use of biological DMARDs in for inflammatory arthritis during pregnancy is finally over: a reappraisal of evidence to optimise pregnancy management.
Lancet Rheumatology
10.1016/S2665-9913(24)00097-3.
(In press).
Text (Article)
Giles_Equipoise in IA pregnancy Final Nov 23 clean version.pdf Access restricted to UCL open access staff until 12 December 2024. Download (243kB) |
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Text (Table)
Giles_Tables for Equipoise in IA final Oct 2023.pdf Access restricted to UCL open access staff until 12 December 2024. Download (206kB) |
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Text (Figure 1)
Equipoise Fig 1. v3.pptx - Accepted Version Access restricted to UCL open access staff until 12 December 2024. Download (280kB) |
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Text (Figure 2)
Equipoise Fig 2. v3.pptx - Accepted Version Access restricted to UCL open access staff until 12 December 2024. Download (281kB) |
Abstract
Active inflammatory arthritis in pregnancy is associated with an increased risk of adverse pregnancy outcomes. Treatment of active inflammation and maintenance of low disease activity with medication reduces these risks. Therapeutic decisions on disease-modifying antirheumatic drugs (DMARDs) in pregnancy are complicated by safety concerns, which have led to inappropriate withdrawal of treatment and consequential harm to mother and fetus. Studies of inflammatory arthritis in pregnancy have consistently shown minimal safety concerns with the use of biological DMARDs and an increased risk of disease flare with discontinuation of biological DMARDs. It is our opinion that during pregnancy, the benefits of disease control with biological DMARDs, when required in addition to conventional synthetic DMARDs, outweigh the risks. In this Series paper, we review the reasons for reconsideration of equipoise and propose an agenda for future research to optimise the use of biological DMARDs in inflammatory arthritis during pregnancy.
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