Steroids and hydroxychloroquine remain the most widely prescribed treatment options for pregnant women with rheumatologic diseases, according to a study looking at prescribing patterns in a cohort of women diagnosed with systemic lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis.
Lead investigator Dr. Rishi J. Desai of Brigham and Women’s Hospital and Harvard Medical School, both in Boston, and his colleagues found that the use of biologic agents during pregnancy, though still low, rose for 2,645 women from all regions of the United States covered by private insurance or Medicaid between 2001 and 2012. The investigators evaluated prescription filling records for steroids, nonbiologic disease-modifying agents, and biologics. The women in the study all had live births. Dr. Desai and his colleagues looked at scripts for individual agents filled in the 3-month period prior to each woman’s pregnancy and during her pregnancy (Arthritis Rheumatol. 2015 Nov 25. doi: 10.1002/art.39521).
Nearly two-thirds of women with psoriatic arthritis or ankylosing spondylitis stopped filling immunomodulatory prescriptions during their pregnancies, while only 26% of lupus and 34.5% of rheumatoid arthritis patients did so. In the cohort as a whole, steroids and hydroxychloroquine were the most frequently used agents in pregnancy (48.4% and 27.1%, respectively). Steroid use during pregnancy dropped over time, from 54.4 per 100 deliveries to 42.4 between 2001 and 2012, while rates for biologics increased from 5.1 per 100 to 16.6 (P less than .001 for both trends).
“More comparative research on the safety of steroids as well as disease-modifying agents used during pregnancy will be critical for providing the necessary evidence to guide treatment decisions in future,” Dr. Desai and his colleagues wrote in their analysis.
The findings also suggest, the investigators wrote, “that with availability of some reassuring data indicating absence of a major fetal adverse event after biologic use in pregnancy, physicians have become more comfortable with continuing treatment with these agents.”
Use of agents potentially harmful to a developing fetus, including methotrexate, mycophenolate mofetil, and leflunomide, was very low in the study. However, the investigators noted, because their study enrolled only women with successful pregnancies, it could have underestimated the use of some of these agents, as women using them may have chosen to terminate their pregnancies.
The study received no outside funding. Two coauthors reported financial relationships with AstraZeneca, and one of them also reported funding from Pfizer and Eli Lilly.