Recommendations for the use of DMARDs in pregnancy and reproductive health for patients with rheumatic disease: A scoping review.

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research Pub Date : 2025-04-21 DOI:10.1002/acr.25558

Athena Chin, Alice Terrett, Mihye Kwon, Samuel Whittle, Catherine Hill

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引用次数: 0

Abstract

Objective: Autoimmune rheumatic diseases commonly affect individuals of childbearing age, with historically increased adverse pregnancy outcomes in this group. The advent of disease-modifying anti-rheumatic drugs (DMARDs) has fostered more suitable conditions for pregnancy; however, this is accompanied by challenges in ensuring safe use in reproductive health. The aim of this review is to compare existing guideline recommendations for the use of DMARDs in pregnancy and reproductive health for patients with rheumatic disease.

Methods: A scoping review was performed with Medline and EMBASE, in addition to a hand search, to identify guidelines published since 2014 by academic societies in rheumatology that addressed management of DMARDs in pregnancy in any of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and systemic lupus erythematosus. Conventional synthetic DMARDs (csDMARDS; methotrexate, sulfasalazine, leflunomide, hydroxychloroquine), biologic DMARDs (bDMARDs; adalimumab, etanercept, infliximab, golimumab, certolizumab, abatacept, tocilizumab, rituximab, anakinra) and targeted synthetic DMARDs (tsDMARDs; tofacitinib, baricitinib, upadacitinib) were targeted. Two authors performed data extraction in duplicate.

Results: 18 guidelines were included. Recommendations for DMARD use in pre-conception were present in 10 (56%), lactation in 12 (67%) and male fertility in 6 (33%). 13 (72%) guidelines included recommendations for csDMARDs, 13 (72%) bDMARDs and 5 (28%) tsDMARDs. There was moderate evidence supporting relatively uniform csDMARD recommendations, compared to minimal evidence for b/tsDMARD use with variable recommendations.

Conclusion: There is heterogeneity in formulation of guidelines on the use of DMARDs in pregnancy. Recommendations for csDMARDs were similar between guidelines. There was significant variability in recommendations for b/tsDMARD use, reflecting current minimal literature in this area.

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风湿病患者妊娠和生殖健康中使用DMARDs的建议：范围综述

目的：自身免疫性风湿性疾病通常影响育龄个体，在这一组中有历史上增加的不良妊娠结局。改善疾病的抗风湿药物（DMARDs）的出现为怀孕创造了更合适的条件；然而，与此同时，在确保生殖健康安全使用方面也面临挑战。本综述的目的是比较风湿性疾病患者妊娠和生殖健康中使用dmard的现有指南建议。方法：通过Medline和EMBASE进行范围综述，并进行手工检索，以确定2014年以来风湿病学术学会发布的关于类风湿关节炎、强直性脊柱炎、银屑病关节炎和系统性红斑狼疮妊娠期dmard管理的指南。常规合成DMARDs (csDMARDS；甲氨蝶呤、磺胺嘧啶、来氟米特、羟氯喹)、生物DMARDs (bDMARDs；阿达木单抗、依那西普、英夫利昔单抗、戈利木单抗、certolizumab、abatacept、tocilizumab、利妥昔单抗、anakinra)和靶向合成DMARDs (tsDMARDs；Tofacitinib, baricitinib, upadacitinib)是靶向药物。两位作者进行了重复的数据提取。结果：共纳入18条指南。建议在孕前使用DMARD的有10例（56%），哺乳期有12例（67%），男性生育期有6例（33%）。13份（72%）指南包括csDMARDs， 13份（72%）bDMARDs和5份（28%）tsDMARDs的建议。有中等证据支持相对统一的csDMARD建议，相比之下，很少有证据支持b/tsDMARD使用不同的建议。结论：妊娠期dmard使用指南的制定存在异质性。指南之间对csdmard的建议是相似的。关于b/tsDMARD使用的建议有很大的差异，反映了目前在这一领域的文献很少。

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

Arthritis Care & Research RHEUMATOLOGY-

CiteScore

9.40

自引率

6.40%

发文量

368

审稿时长

3-6 weeks

期刊介绍： Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.