The time of equipoise on the use of biological DMARDs in for inflammatory arthritis during pregnancy is finally over: a reappraisal of evidence to optimise pregnancy management

IF 15 1区医学 Q1 RHEUMATOLOGY

Lancet Rheumatology Pub Date : 2024-08-01 DOI:10.1016/S2665-9913(24)00097-3

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引用次数: 0

Abstract

Active inflammatory arthritis in pregnancy is associated with an increased risk of adverse pregnancy outcomes. Treatment of active inflammation and maintenance of low disease activity with medication reduces these risks. Therapeutic decisions on disease-modifying antirheumatic drugs (DMARDs) in pregnancy are complicated by safety concerns, which have led to inappropriate withdrawal of treatment and consequential harm to mother and fetus. Studies of inflammatory arthritis in pregnancy have consistently shown minimal safety concerns with the use of biological DMARDs and an increased risk of disease flare with discontinuation of biological DMARDs. It is our opinion that during pregnancy, the benefits of disease control with biological DMARDs, when required in addition to conventional synthetic DMARDs, outweigh the risks. In this Series paper, we review the reasons for reconsideration of equipoise and propose an agenda for future research to optimise the use of biological DMARDs in inflammatory arthritis during pregnancy.

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对妊娠期炎症性关节炎使用生物 DMARDs 的一致看法终于结束了：重新评估证据，优化妊娠管理。

妊娠期活动性炎症性关节炎会增加不良妊娠结局的风险。通过药物治疗活动性炎症并维持较低的疾病活动度可以降低这些风险。妊娠期使用改变病情抗风湿药（DMARDs）的治疗决策因安全性问题而变得复杂，这导致了不适当的停药，并对母亲和胎儿造成了伤害。对妊娠期炎症性关节炎的研究一致表明，使用生物制剂 DMARDs 的安全性极低，而停用生物制剂 DMARDs 则会增加疾病复发的风险。我们认为，在妊娠期间，除了常规合成的DMARDs外，使用生物DMARDs控制疾病的益处大于风险。在这篇系列论文中，我们回顾了重新考虑等效的原因，并提出了未来的研究议程，以优化妊娠期炎症性关节炎患者使用生物 DMARDs 的情况。

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来源期刊

Lancet Rheumatology RHEUMATOLOGY-

CiteScore

34.70

自引率

3.10%

发文量

279

期刊介绍： The Lancet Rheumatology, an independent journal, is dedicated to publishing content relevant to rheumatology specialists worldwide. It focuses on studies that advance clinical practice, challenge existing norms, and advocate for changes in health policy. The journal covers clinical research, particularly clinical trials, expert reviews, and thought-provoking commentary on the diagnosis, classification, management, and prevention of rheumatic diseases, including arthritis, musculoskeletal disorders, connective tissue diseases, and immune system disorders. Additionally, it publishes high-quality translational studies supported by robust clinical data, prioritizing those that identify potential new therapeutic targets, advance precision medicine efforts, or directly contribute to future clinical trials. With its strong clinical orientation, The Lancet Rheumatology serves as an independent voice for the rheumatology community, advocating strongly for the enhancement of patients' lives affected by rheumatic diseases worldwide.