Fertility Unaffected by Biologic Therapy in Women With RA, PsA

Einat Haikin Herzberger, MD

Credit: Linkedin

Biologic treatment for rheumatoid arthritis (RA) or psoriatic arthritis (PsA) did not negatively affect fertility in women, according to a recent study published by Elsevier in Seminars in Arthritis and Rheumatism.¹

“Although used frequently, knowledge regarding the possible effects of bDMARDs on aspects of fertility remains limited… Women with RA have been reported to have fewer offspring than intended, experience prolonged time to conception, and have a higher incidence of sub-fertility compared to the general population²,” lead investigator Einat Haikin Herzberger, MD, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, and School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Israel, and colleagues wrote.¹

Herzberger and colleagues conducted a retrospective cohort study based on an electronic health record (EHR) that included 4517 women with RA and 1415 women with PsA between the ages of 18 and 40 years old. Biologics in use included tumor necrosis factor inhibitors, anti-CD-20 monoclonal antibodies, interleukin blockers and T-cell inhibitors. The study’s main outcome measure was positive pregnancy test rate and secondary outcome measures were pregnancy attempts and use of in vitro fertilization (IVF).¹

Participants with RA and PsA had similar mean ages at diagnosis (respectively, 30.7; standard deviation [SD], 6.3 vs. 30.9; SD, 6; P = .260) and at biologic initiation (respectively, 34.2; SD, 8 vs. 34.2; SD, 7.5 years; P = .729).¹

The investigators found that fertility was higher before diagnosis in both groups, with rates of positive beta-hCG tests decreasing from 84.5% to 63.6% in the RA group and from 87.1% to 61.4% in the PsA group (both P <.01 for both comparisons). Initiating biologics did not negatively affect beta-hCG test rate, with women with PsA showing a trend toward an increased likelihood of achieving pregnancy after initiating biologic treatment (P =.05), while the rates remained stable in women with RA.¹

Additionally, Herzberger and colleagues found that beta hCG testing increased in both groups after initiation of biological treatments (RA, P <.01; PsA, P =.07). Comparing women with RA initiating biologics compared with women with RA or PsA who did not initiate biologics, crude rates of positive beta-hCG were 229/431 (53.1%), 1120/1743 (64.3%), and 318/492 (64.6%) respectively, with no significant differences between groups.¹

Use of fertility medications before diagnosis was about 8.35% in the RA group and 8.4% in the PsA group (both P >.5) and dropped after diagnosis but before exposure to approximately 4% in both groups (P >.5) but recovered to 8.3% in the RA group and 7% in the PsA group (P >.5). IVF rate in the RA group decreased after exposure (P <.01) but was not significantly different in the PsA group (P =.56).¹

“The large cohort analyzed in this database study provides novel, reassuring data regarding spontaneous and medicated fertility in women with RA and PsA exposed to biological medications. Further studies to differentiate between sub-categories of bDMARDs, as well as data on live births are warranted,” Herzberger and colleagues concluded.¹

REFERENCES

1. Herzberger EH, Hornik-Lurie T, Levi Y, et al. The effect of biological treatment on female fertility: A cohort study of women with rheumatoid arthritis and psoriatic arthritis. Semin. Arthritis Rheum. Published online December 20, 2024. doi: 10.1016/j.semarthrit.2024.152608

2. Brouwer J, Hazes JM, Laven JS, Dolhain RJ. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis 2015;74 (10):1836–41