Reumatizam, Vol. 70 No. 1, 2023.
Pregledni rad
https://doi.org/10.33004/reumatizam-70-1-5
IMMUNOMODULATORY ANTIRHEUMATIC DRUGS AND NON-STEROIDAL ANTI-INFLAMMATORY DRUGS IN PRE-CONCEPTION, PREGNANCY AND BREASTFEEDING – A REVIEW OF THE GUIDELINES
Kristina Frketić Marović
orcid.org/0009-0008-1422-9283
; Department of Internal Medicine, Zadar General Hospital, Zadar, Croatia
Sažetak
The course and outcome of pregnancy can be affected by the activity of the inflammatory rheumatic disease itself and by the drugs we use. Evidence on the safe use of drugs during pregnancy is largely lacking due to the observational nature of the studies conducted and the difficulty of conducting clinical trials in pregnancy. The current guidelines of the professional and scientific societies of rheumatology — the European Alliance of Associations for Rheumatology (EULAR), the American College of Rheumatology (ACR) and the British Society for Rheumatology (BSR) are analysed and consolidated in this review paper. Drugs like methotrexate, leflunomide, mycophenolate mofetil, cyclophosphamide and Janus kinase inhibitors (JAK inhibitors) are contraindicated in pregnancy and should be avoided during pregnancy planning and replaced by drugs that are compatible with pregnancy. Immunomodulators that are considered compatible with pregnancy are prednisone, hydroxychloroquine, sulfasalazine, azathioprine, cyclosporine, tacrolimus, colchicine, dapsone and most biologic drugs. When it comes to biologics, tumour necrosis factor inhibitors (TNF-inhibitors) are the most studied drugs and all of them are safe to use in the first and second trimesters of pregnancy. Certolizumab is considered to be the safest due to almost no placental transfer. There is still insufficient evidence for other biologic drugs, and it is recommended to discontinue them before pregnancy/when pregnancy is confirmed. The use of all biologic drugs can be continued throughout the pregnancy if they are necessary to establish control over the activity of the mother’s severe/life-threatening disease. Effective drug treatment of an active inflammatory rheumatic disease is possible with reasonable safety for the mother and the foetus/child during pregnancy and lactation nowadays.
Ključne riječi
rheumatic disease, pregnancy, breastfeeding, glucocorticoids, DMARDs, biologics
Hrčak ID:
313706
URI
Datum izdavanja:
23.1.2024.
Posjeta: 206 *