EULAR recommendations for use of antirheumatic drugs in reproduction, pregnancy, and lactation: 2024 update.

IF 20.3 1区 医学 Q1 RHEUMATOLOGY
Annals of the Rheumatic Diseases Pub Date : 2025-06-01 Epub Date: 2025-04-26 DOI:10.1016/j.ard.2025.02.023
Linda Rüegg, Andrea Pluma, Sabrina Hamroun, Irene Cecchi, Luis Fernando Perez-Garcia, Philip O Anderson, Laura Andreoli, Sara Badreh Wirström, Vladimira Boyadhzieva, Christina Chambers, Nathalie Costedoat-Chalumeau, Radboud J E M Dolhain, Rebecca Fischer-Betz, Ian Giles, Carina Gøtestam-Skorpen, Maria Hoeltzenbein, Francesca Marchiori, Karoline Mayer-Pickel, Anna Molto, Catherine Nelson-Piercy, Ole Haagen Nielsen, Angela Tincani, Marianne Wallenius, Astrid Zbinden, Yvette Meissner, Axel Finckh, Frauke Förger
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引用次数: 0

Abstract

Objectives: To update the existing European Alliance of Associations for Rheumatology (EULAR) points to consider (PtC) for use of antirheumatic drugs in reproduction, pregnancy, and lactation, including additional drugs and adverse outcomes as well as paternal drug safety.

Methods: According to the EULAR standardised operating procedures, an international task force (TF) defined the questions for a systematic literature review, followed by formulation of the updated statements. A predefined voting process was applied to each overarching principle and statement. Level of evidence and strength of recommendation were assigned, and participants finally provided their level of agreement for each item.

Results: The TF proposes 5 overarching principles and 12 recommendations for the use of antirheumatic drugs before and during pregnancy, through lactation, and in male patients. The current evidence indicates that synthetic disease-modifying antirheumatic drugs (DMARDs) compatible with pregnancy include antimalarials, azathioprine, colchicine, cyclosporine, sulfasalazine, and tacrolimus. Regarding nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids, a more restrictive approach to their use during pregnancy is recommended. Based on an individualised risk-benefit assessment, all tumour necrosis factor inhibitor (TNFi) biologic DMARDs (bDMARDs) can be used throughout pregnancy, and non-TNFi bDMARDs may be used if needed. In relation to lactation, compatible drugs include antimalarials, azathioprine, colchicine, cyclosporine, glucocorticoids, intravenous immunoglobulin (IVIG), NSAIDs, sulfasalazine, and tacrolimus. All bDMARDs are considered compatible with breastfeeding. Concerning the use of drugs in men, compatible options include antimalarials, azathioprine, colchicine, cyclosporine, IVIG, leflunomide, methotrexate, mycophenolate, NSAIDs, glucocorticoids, sildenafil, sulfasalazine, tacrolimus, and bDMARDs.

Conclusions: The updated recommendations provide consensus guidance and will help to improve the quality of care of patients during the phases of reproduction, pregnancy, and lactation.

EULAR关于生殖、妊娠和哺乳期使用抗风湿药物的建议:2024年更新。
目的:更新现有的欧洲风湿病协会联盟(EULAR)要点,考虑(PtC)在生殖、妊娠和哺乳期使用抗风湿药物,包括额外的药物和不良后果以及父亲药物安全性。方法:根据EULAR标准化操作程序,一个国际工作组(TF)定义了系统文献综述的问题,然后制定了更新的陈述。对每项总体原则和声明都采用了预先确定的投票程序。分配了证据水平和推荐强度,参与者最终提供了他们对每个项目的同意程度。结果:工作组提出了5项总体原则和12项建议,适用于妊娠前和妊娠期间、哺乳期和男性患者使用抗风湿药物。目前的证据表明,与妊娠相容的合成疾病缓解抗风湿药物(DMARDs)包括抗疟药、硫唑嘌呤、秋水仙碱、环孢素、磺胺嘧啶和他克莫司。关于非甾体抗炎药(NSAIDs)和糖皮质激素,建议在怀孕期间使用更严格的方法。基于个体化风险-收益评估,所有肿瘤坏死因子抑制剂(TNFi)生物dmard (bdmard)可在整个妊娠期间使用,必要时也可使用非TNFi bdmard。与泌乳相关的相容药物包括抗疟药、硫唑嘌呤、秋水仙碱、环孢素、糖皮质激素、静脉注射免疫球蛋白(IVIG)、非甾体抗炎药、柳氮磺胺吡啶和他克莫司。所有bdmard都被认为与母乳喂养兼容。关于男性的药物使用,兼容的选择包括抗疟药、硫唑嘌呤、秋水仙碱、环孢素、IVIG、来氟米特、甲氨蝶呤、霉酚酸盐、非甾体抗炎药、糖皮质激素、西地那非、磺胺吡啶、他克莫司和bDMARDs。结论:更新的建议提供了共识指导,将有助于提高患者在生育、妊娠和哺乳期的护理质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of the Rheumatic Diseases
Annals of the Rheumatic Diseases 医学-风湿病学
CiteScore
35.00
自引率
9.90%
发文量
3728
审稿时长
1.4 months
期刊介绍: Annals of the Rheumatic Diseases (ARD) is an international peer-reviewed journal covering all aspects of rheumatology, which includes the full spectrum of musculoskeletal conditions, arthritic disease, and connective tissue disorders. ARD publishes basic, clinical, and translational scientific research, including the most important recommendations for the management of various conditions.
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