Drug Insight: anti-tumor necrosis factor therapy for inflammatory arthropathies during reproduction, pregnancy and lactation

• Published in: Nature clinical practice. Rheumatology Vol. 3; no. 3; pp. 156 - 164
• Main Authors: Skomsvoll, Johan F, Wallenius, Marianne, Koksvik, Hege S, Rødevand, Erik, Salvesen, Kjell Å, Spigset, Olav, Kvien, Tore K
• Format: Journal Article
• Language: English
• Published: United States Nature Publishing Group 01-03-2007
• Subjects: Animals; Antirheumatic agents; Antirheumatic Agents - adverse effects; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Complications and side effects; Disease Models, Animal; Dosage and administration; Drug therapy; Female; Health aspects; Humans; Immunosuppressive Agents - adverse effects; Joint diseases; Lactation - drug effects; Pregnancy; Pregnancy Complications - drug therapy; Pregnancy Complications - immunology; Risk factors; Spondylitis, Ankylosing - complications; Spondylitis, Ankylosing - drug therapy; Tumor necrosis factor; Tumor Necrosis Factor-alpha - antagonists & inhibitors; United States
• ISSN: 1745-8382; 1745-8390
• DOI: 10.1038/ncprheum0426

Tumor necrosis factor (TNF) antagonists are widely used to reduce disease activity and joint damage, and to improve health-related quality of life in patients suffering from rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis. To date, no increased risk of embryotoxicity or teratogenicity, or adverse pregnancy outcome (such as birth defects, premature birth, and low birth weight) has been reported in patients with inflammatory arthropathies treated with anti-TNF therapy, compared with the general population. However, the available data are limited, and methotrexate, which is commonly used in combination with anti-TNF drugs, is teratogenic. Until more data are available, no firm conclusions can be reached regarding the safety of anti-TNF therapy in pregnancy. Nevertheless, in selected cases where there is high disease activity, anti-TNF therapy might be recommended, depending on the results of individual risk-benefit analyses. Fully informed consent from the mother is needed in such cases. Anti-TNF agents are not usually used during lactation, although the risk of toxicity is probably negligible.