Management of RA medications in pregnant patients

被引:103
作者
Ostensen, Monika [1 ]
Foerger, Frauke [1 ]
机构
[1] Univ Hosp Bern, Dept Rheumatol Clin Immunol & Allergol, CH-3010 Bern, Switzerland
关键词
NONSTEROIDAL ANTIINFLAMMATORY DRUGS; LOW-DOSE METHOTREXATE; INFLAMMATORY-BOWEL-DISEASE; RHEUMATOID-ARTHRITIS; CONGENITAL-ANOMALIES; MATERNAL EXPOSURE; IMMUNOSUPPRESSIVE DRUGS; CROHNS-DISEASE; WOMEN; SAFETY;
D O I
10.1038/nrrheum.2009.103
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
A desire for children or the presence of pregnancy limits the drug therapy options for a woman with rheumatoid arthritis. Combination therapies that include methotrexate or new drugs that have not been studied or used in pregnant patients must be excluded, even though they might be highly efficacious. with few exceptions, the reason for this exclusion is not the proven teratogenicity of the drugs, but the absence of proven safety for the fetus. whereas methotrexate, leflunomide, abatacept and rituximab must be withdrawn before a planned pregnancy, tumor necrosis factor inhibitors and bisphosphonates can be continued until conception. Antimalarial agents, sulfasalazine, azathioprine and ciclosporin are compatible with pregnancy, and so can be administered until birth. Corticosteroids and analgesics such as paracetamol (acetaminophen) can also be used throughout pregnancy. NSAIDs can be safely administered until gestational week 32. The most important consideration when managing rheumatoid arthritis medications during pregnancy is that therapy must be tailored for the individual patient according to disease activity.
引用
收藏
页码:382 / 390
页数:9
相关论文
共 86 条
[1]   Analysis of nonsteroidal antiinflammatory drugs in meconium and its relation to persistent pulmonary hypertension of the newborn [J].
Alano, MA ;
Ngougmna, E ;
Ostrea, EM ;
Konduri, GG .
PEDIATRICS, 2001, 107 (03) :519-523
[2]  
[Anonymous], 2008, RIT RIT IR DEXTR INJ
[3]  
Armenti Vincent T, 2004, Clin Transpl, P103
[4]  
BAR OB, 2001, TRANSPLANTATION, V71, P1051, DOI DOI 10.1097/00007890-200104270-00006
[5]  
Barrett JH, 1999, ARTHRITIS RHEUM, V42, P1219, DOI 10.1002/1529-0131(199906)42:6<1219::AID-ANR19>3.0.CO
[6]  
2-G
[7]  
Bawle EV, 1998, TERATOLOGY, V57, P51, DOI 10.1002/(SICI)1096-9926(199802)57:2<51::AID-TERA2>3.0.CO
[8]  
2-9
[9]   Exposition to anti-TNF drugs during pregnancy: Outcome of 15 cases and review of the literature [J].
Berthelot, Jean-Marie ;
De Bandt, Michel ;
Goupille, Philippe ;
Solau-Gervais, Elisabeth ;
Liote, Frederic ;
Goeb, Vincent ;
Azais, Isabelle ;
Martin, Antoine ;
Pallot-Prades, Beatrice ;
Maugars, Yves ;
Mariette, Xavier .
JOINT BONE SPINE, 2009, 76 (01) :28-34
[10]  
Brent RL, 2001, TERATOLOGY, V63, P106