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Lupus Treatment Advised Despite Pregnancy Concern


 

SNOWMASS, COLO. — Lupus treatment should not be discontinued in anticipation of a pregnancy, Dr. W. Joseph McCune said at a symposium sponsored by the American College of Rheumatology.

Terminating drug treatment results in flares, and it is now clear that “there is really nothing worse for a lupus pregnancy than a flare, either immediately before the pregnancy or during the pregnancy,” said Dr. McCune, director of rheumatology outpatient services at the University of Michigan, Ann Arbor.

The use of hydroxychloroquine during pregnancy in lupus patients is receiving increased interest from specialists, he said.

Instead of cessation of therapy, many physicians are trying to continue their patients on a corticosteroid (when necessary) and hydroxychloroquine, with informed consent and disclosure that the drug is known to cross the placenta.

Hydroxychloroquine is a drug that is not the most potent agent for resolving manifestations of lupus, but one that is very good at preventing serious disease developments and flares, Dr. McCune said.

Antimalarials have a number of potentially beneficial side effects, such as improving glucose tolerance, noted Dr. McCune, who previously reviewed and reported on evidence suggesting that antimalarials positively affect both cholesterol levels and thrombosis in lupus patients with increased cardiovascular risk.

There have been no apparent adverse fetal effects, and “in general, the experience has been that there have been no difficulties using this drug,” in reports of some 300 lupus patients treated with hydroxychloroquine during pregnancy, he said.

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