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.


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