Pregnant women with rheumatoid arthritis (RA) could use specific drugs to treat their condition without increasing the health risks to their unborn babies, according to a new Canadian study.
Research led by the Research Institute of the McGill University Health Centre (RI-MUHC) in Montreal, Quebec, found that tumour necrosis factors inhibitors (TNFs), which are commonly used to reduce inflammation and relieve pain, did not expose babies to any significant excess risk of serious side effects compared to unexposed children from mothers with RA and children from the general population.
The research findings are published in the latest edition of Arthritis & Rheumatology.
First author Dr Évelyne Vinet and her team from the Centre for Outcomes of Evaluative Research (CORE) showed that although TNFs cross the placenta, the drug may not increase immunosuppression nor compromise the child’s ability to fight infections.
"Knowing there is not necessarily an association between infections and these RA drugs will be very reassuring to expectant mothers," said Dr Vinet, an assistant professor in the Department of Medicine and Division of Rheumatology at the Faculty of Medicine of McGill University.
"It is important to highlight these findings so would-be mothers understand they can enjoy a normal pregnancy without being burdened by unnecessary stress."
The team studied nearly 3,000 children from mothers with RA and a random selected group of nearly 15,000 children during their first year of life. They defined TNFi exposure based on at least one filled prescription during pregnancy.
Within the RA group, 380 children were exposed to TNFs and 3.2% presented serious infections, compared to 2% among those who had no exposure to TNFs and 1.9% in the control group.
“Our study provides new evidence to counsel RA women contemplating pregnancy,” said Dr Vinet.
“Within the largest cohort of RA offspring exposed to TNFis ever assembled, we did not observe a marked excess risk for serious infections versus unexposed RA offspring and children from the general population.
“Our data are potentially reassuring, however, we could not exclude a differential risk according to specific TNFi characteristics, with infliximab potentially resulting in a three-fold increase in the risk of serious infections compared with other TNFis.”
Vinet E, De Moura C, Pineau C et al. Serious infections in rheumatoid arthritis offspring exposed to tumour necrosis factor a inhibitors: cohort study. Arthritis & Rheumatology 17 May, 2018; doi: 10.1002/art.40536.
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