My last SharePost discussed nursing women who suffer from rheumatoid arthritis. Today, it would be worthwhile to discuss the pregnant rheumatoid arthritis patient.
There is an ongoing data base which follows pregnant rheumatoid arthritis patients, maintained by the Organization of Teratology Information Services (OTIS). They have data on 33 pregnant rheumatoid arthritis patients who have been exposed to either Enbrel or Remicade. There was no increased incidence of fetal malformations. Normal deliveries have been reported in rheumatoid arthritis patients exposed to such drugs in the first trimester and throughout pregnancy.
The British Society of Rheumatology Biologics Register described patients exposed to Enbrel, Remicade, and Humira at conception. There were six first trimester miscarriages, three elective abortions and 13 live births.
There is no evidence that Enbrel, Remicade or Humira decrease fertility or cause miscarriages. Further, there is no evidence that such drugs cause toxicity to the embryo, whether it be in the form of birth defects or other manifestations.
Interestingly, these anti-tumor necrosis factor drugs have been proposed as a treatment for infertility, perhaps through the beneficial reduction in tumor necrosis factor.
Currently, Enbrel, Remicade and Humira are classified as category B; that is, there is no documented human toxicity. There has been no definitive evidence of toxicity to the mother, the embryo, or the fetus.
That being said, there are few human studies available specifically gathering data on this subject of pregnancy and medication use in rheumatoid arthritis. It is known that Enbrel, Remicade and Humira are not transferred to any significant degree across the placenta in the first trimester. But there is not a lot known about transfer during the second and third trimesters.
So we still need more studies, more data gathered in registries studying pregnant women with rheumatoid arthritis.
At this point in time, I avoid the biologic agents Enbrel, Remicade and Humira during pregnancy or during the time in which a woman might be attempting to become pregnant. If needed, I will treat with low dose prednisone, just so a woman is not suffering to any great degree, and because prednisone (particularly in low dosages) is a safe drug with little crossing of the placenta.