Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

TNFi Discontinuation Before Gestational Week 20

Arthritis Rheumatol; ePub 2019 Jan 21; Förger, et al

Discontinuing a tumor necrosis factor inhibitor (TNFi) before gestational week 20 seems feasible in women with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) who enter pregnancy with well‐controlled disease, a recent study found. Pregnant women with RA and JIA were enrolled in the Organization of Teratology Information Specialists (OTIS) Autoimmune Diseases in Pregnancy Project, a prospective cohort study. Information about medication and disease activity (patient‐reported outcome measures) were collected prior to gestational week 20 and at gestational week 32. Researchers found:

  • Among 490 women enrolled between 2005 and 2017 (397 with RA, 93 with JIA), 122 (24.9%) discontinued a TNFi before gestational week 20, 201 (41.0%) used a TNFi beyond week 20, and 167 (34.1%) did not use a TNFi during pregnancy.
  • At the time of enrollment, disease activity was low to minimal in 72.9% of women.
  • TNFi discontinuation was not associated with a clinically important worsening of patient reported outcome measures at the third trimester.
  • Univariate, but not multivariate, analysis showed that women using TNFi beyond week 20 were more likely to experience improved disease activity scores at the third trimester.

Citation:

Förger F, Bandolo G, Luo Y, Robinson L, Johnson DL, Chambers CD. Discontinuing TNF‐inhibitors before gestational week 20 in well‐controlled rheumatoid arthritis and juvenile arthritis is not associated with a disease worsening in late pregnancy. [Published online ahead of print January 21, 2019]. Arthritis Rheumatol. doi:10.1002/art.40821.

This Week's Must Reads

Long-term Opioid Use with Severe OA by Geography, Arthritis Rheumatol; ePub 2019 Jan 28; Desai, et al

Family History of Psoriasis and Psoriatic Disease, Arthritis Care Res; ePub 2019 Jan 25; Solmaz, et al

Remission/Low Disease Activity Protective in SLE , Lupus; ePub 2019 Jan 24; Alarcón, Ugarte-Gil, et al

Dietary Niacin Linked with Incident Hip Fracture, J Bone Miner Res; ePub 2019 Jan 19; Carbone, et al

Sleep Quality, Sleep Disorders in People with Gout, Arthritis Res Ther; ePub 2019 Jan 25; Singh

Must Reads in Rheumatoid Arthritis

TNF inhibitor prices rose despite increased drug class competition, San-Juan-Rodriguez A et al. JAMA Intern Med. 2019 Feb 18. doi: 10.1001/jamainternmed.2018.7656

Examining Brain Correlates of Clinical Pain in RA, Arthritis Care Res; 2019 Feb; Lee, Fine, et al

Obesity/Weight Loss Linked to Mortality Risk in RA, Clin Exp Rheumatol; ePub 2019 Jan 18; Baker, et al

Study Does Not Back MRI-Guided Treatment Strategy, JAMA; ePub 2019 Feb 5; Møller-Bisgaard, et al

Remission Frequency and LDA in Patients with RA, Semin Arthritis Rheumatol; ePub 2018 Dec 28; Scott, et al