TNF inhibitors found not associated with adverse pregnancy outcomes

Continued use of tumor necrosis factor (TNF) inhibitors during pregnancy is not associated with adverse fetal or obstetric outcomes and may even reduce the risk of serious maternal infections, according to new findings presented at the 2023 American College of Rheumatology (ACR) Annual Meeting.¹

Clinicians frequently prescribe TNF inhibitors such as infliximab and adalimumab to treat inflammatory arthritis, which have proven resistant to other treatments. Although previous studies have shown they are safe during pregnancy, many people stop using them because of concerns about potential harm to the fetus.²

While drugs such as methotrexate do have the potential to cause serious fetal complications, the researchers of the new study of TNF inhibitors note that they are not considered teratogens. This fact had been noted before their study and could increase pregnant parents’ understanding of the drug’s effects.

Previous studies on TNF inhibition and its effects on pregnancy have also yielded findings related to similar outcome measures.³ This study further adds to the existing literature on this topic.

To understand the safety of continuous use of TNF inhibitors during pregnancy, a team led by Anna Molto, MD, PhD, HDR, a rheumatologist and researcher at Hospital Cochin in Paris, France, extracted data from a national health survey and France’s insurance database to simulate A randomized clinical trial.²

The observational study used data from more than 2,000 women who received TNF blockers to treat rheumatoid arthritis (RA) or spondyloarthritis between 2008 and 2017. Among these women with chronic rheumatic inflammatory disease (CRID), 2082 were pregnant), 579 reported RA, and 1503 reported spondyloarthritis.

The researchers noted that 72% (1,497 of 2,082 people) stopped taking the medication after discovering they were pregnant.¹ The average age of the women in the study was 31 years when they started becoming pregnant, and the average duration of the disease was 4 years.

Overall, the team’s findings showed that there were no statistically significant differences between adverse fetal, obstetric or infant outcomes in the data they examined. They also found that women who continued to suppress TNF were actually less likely to be hospitalized for serious infections during pregnancy and within 6 weeks postpartum compared with women who stopped treatment.

“While we hypothesized that pregnancy outcomes would be at least comparable between the two groups, we do not expect that the risk of maternal infection will be reduced in patients who continue to receive TNFi therapy because these treatments are known to increase the risk of infection,” Molto said. to the statement.²

Molteau also noted that these findings may be the result of less concurrent use of corticosteroids. That said, the team found no results to confirm this theory.

The next phase of the study by Molteau and colleagues may involve testing this hypothesis through a randomized controlled trial.

The data described here were funded by the French Ministry of Health Grant Program.

1. ^{Molto A, ajrouche A, Tran D, Costedoat-Chalumeau N, Elefant E, Tsatsaris V, Fresson J, Bader-Meunier B, Fautrel B, Tubach F. Continued use of TNFi after pregnancy diagnosis in women with chronic rheumatic inflammation versus Worse obstetric or infant outcomes appear to reduce the risk of serious maternal infections: results from the BioGRIC simulated target trial (abstract). Arthritis Rheumatism. 2023;75(Supplement 9). https://acrabstracts.org/abstract/continuing-tnfi-after-pregnancy-diagnosis-in-women-with-chronic-rheumatic-lingual-diseases-is-not-linked-with-worse-obstetrical-or-infant- The results appear to reduce the risk of maternal serious illness. Accessed: November 11, 2023.}
2. ^{Studies have found that TNF blockers are not associated with adverse pregnancy outcomes. American College of Rheumatology. November 7, 2023. Accessed: November 11, 2023. https://rheumatology.org/press-releases/study-finds-tnf-blockers-are-not-linked-with-poor-pregnancy-outcomes.}
3. ^{Use of TNF inhibitors during pregnancy does not increase the risk of serious infections in children. HCPLive. May 21, 2018. Accessed: November 11, 2023. https://www.hcplive.com/view/tnf-inhibitor-use-pregnancy-does-not-raise-serious-infection-risk-children.}