A decline in the use of tumor necrosis factor-alpha inhibitors (TNFi) was observed in the second and third trimester of pregnancy, according to a large US observational study that examined treatment patterns in pregnant women with underlying chronic inflammatory conditions.
Using a validated claims-based algorithm, study authors identified pregnancies among women 15-54 years of age from the US Sentinel System between January 1 2004 and September 30 2015. “We assessed proportion of infliximab, etanercept, adalimumab, certolizumab pegol, and golimumab by calendar year, indication, and maternal age, and compared them to proportions in an age‐matched, indication‐matched, and date‐matched nonpregnant cohort,” the authors explained.
Results showed that TNFi use was associated with 2,990 out of 19,681 pregnancies associated with an underlying inflammatory condition that ended in a live birth. In both cohorts (pregnant and non-pregnant), TNFi use was highest in patients with psoriatic arthritis (PsA) and lowest in those with psoriasis. Compared with the matched non-pregnant cohort, older pregnant women (45-54 years old) were more likely to be treated with TNFis.
Among patients with ankylosing spondylitis, juvenile idiopathic arthritis, PsA, psoriasis, and rheumatoid arthritis, etanercept was the most frequently used TNFi, while in patients with ulcerative colitis and Crohn’s disease, infliximab was preferred. After the first trimester, TNFi use was found to decline, likely due to a desire to reduce fetal exposure and minimize infection risk in infants administered live vaccines, according to the authors.
Based on the findings of the study, the authors concluded that despite the availability of other TNFis, etanercept was commonly used during pregnancy. “Given that new data show that certolizumab does not cross the placenta, current usage patterns during pregnancy may change,” they noted, adding that “Future research would be needed to examine more recent trends and to evaluate factors associated with TNFi selection during pregnancy and how these factors differ in a non‐pregnant population.”
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