Anna Moto, MD, PhD, HDR

Credit: X (Twitter)

The continuation of tumor necrosis factor (TNF) inhibitors while pregnant is not linked to adverse fetal or obstetric outcomes could even diminish risk of severe maternal infections, according to new findings presented at the annual American College of Rheumatology (ACR) Convergence 2023.¹

TNF inhibitors such as infliximab and adalimumab are often prescribed by clinicians for treatment of inflammatory arthritis that has been shown to resist other treatments. While prior research has suggested that they are safe during pregnancies, many individuals will discontinue them out of fear about potential harm to the fetus.²

Although medications like methotrexate do have the potential to cause severe fetal complications, the investigators of this new study looking at TNF inhibitors note that they are not recognized as teratogens. This fact was noted prior to their research and can add to pregnant parents’ understanding of the medications’ effects.

Prior studies looking at TNF inhibition and its effects on pregnancies have also concluded in findings related to similar outcome measures.³ This research further added to existing literature on the topic.

In order to look at the safety of continual use of TNF inhibitors at the time of pregnancy, a team led by Anna Molto, MD, PhD, HDR, a rheumatologist and researcher for Cochin Hospital in Paris, France, drew data from a nationwide health insurance database in France to simulate a randomized clinical trial.²

The observational research involved the use of data on over 2,000 women who had been treated with TNF blockers for rheumatoid arthritis (RA) or for spondyloarthritis in the timeframe between 2008 - 2017. Among the 2082 pregnancies in these women with chronic rheumatic inflammatory diseases (CRID), 579 reported having RA and 1503 reported having spondyloarthritis.

The investigators noted that 72%—1,497 of the 2,082—discontinued the medication upon finding out about their pregnancies.¹ Those in the study had a mean age of 31 years at the beginning of their pregnancies and a mean duration of disease of 4 years.

Overall, the research team’s findings indicated that there were no statistically significant distinctions in poor fetal, obstetric, or infant outcomes among those of which they had examined the data. They also found that the women who had continued TNF inhibition actually ended up having a diminished likelihood of hospitalization resulting from severe infections during pregnancy and 6 weeks postpartum versus individuals who stopped their treatment.

“Although we had hypothesized that pregnancy outcomes would at least be comparable in both groups, we did not expect to have a lower risk of maternal infections in patients continuing TNFi, as infection risk is known to be increased with these treatments,” Molto said in a statement.²

Molto also noted that these findings may be the result of lower concomitant use of corticosteroids. That said, the team did not find any results to confirm such a theory.

The next phase of this research for Molto and colleagues could involve the testing of this hypothesis through the use of a randomized controlled trial.

The data described here was funded by the French Ministry of Health Funding Program.

References

1. ^{Molto A, ajrouche a, Tran D, Costedoat-Chalumeau N, Elefant E, Tsatsaris V, Fresson J, Bader-Meunier B, Fautrel B, Tubach F. Continuing TNFi After Pregnancy Diagnosis in Women with Chronic Rheumatic Inflammatory Diseases Is Not Associated with Worse Obstetrical or Infant Outcomes and Seems to Reduce Risk of Maternal Severe Infection: The Results of the Emulated Target Trial BioGRIC [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/continuing-tnfi-after-pregnancy-diagnosis-in-women-with-chronic-rheumatic-inflammatory-diseases-is-not-associated-with-worse-obstetrical-or-infant-outcomes-and-seems-to-reduce-risk-of-maternal-severe/. Accessed November 11, 2023.}
2. ^{Study Finds TNF Blockers Are Not Associated with Poor Pregnancy Outcomes. American College of Rheumatology. November 7, 2023. Date accessed: November 11, 2023. https://rheumatology.org/press-releases/study-finds-tnf-blockers-are-not-associated-with-poor-pregnancy-outcomes.}
3. ^{TNF Inhibitor Use in Pregnancy Does Not Raise Serious Infection Risk in Children. HCPLive. May 21, 2018. Date accessed: November 11, 2023. https://www.hcplive.com/view/tnf-inhibitor-use-pregnancy-does-not-raise-serious-infection-risk-children.}