Leflunomide use during pregnancy and the risk of adverse pregnancy outcomes

Bérard, Anick; Zhao, Jinping; Shui, Irene M.; Colilla, Susan

doi:10.1136/annrheumdis-2017-212078

Cited by 43 publications

(21 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For women treated with leflunomide, we strongly recommend cholestyramine washout if there are detectable serum levels of metabolite prior to or as soon as pregnancy is confirmed. Once metabolite is not detectable in the serum, the risks of pregnancy loss and birth defects are not elevated ( ).…”

Section: Results/recommendationsmentioning

confidence: 99%

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

Sammaritano

Bermas

Chakravarty

et al. 2020

Arthritis & Rheumatology

437

520

View full text Add to dashboard Cite

Objective To develop an evidence‐based guideline on contraception, assisted reproductive technologies (ART), fertility preservation with gonadotoxic therapy, use of menopausal hormone replacement therapy (HRT), pregnancy assessment and management, and medication use in patients with rheumatic and musculoskeletal disease (RMD). Methods We conducted a systematic review of evidence relating to contraception, ART, fertility preservation, HRT, pregnancy and lactation, and medication use in RMD populations, using Grading of Recommendations Assessment, Development and Evaluation methodology to rate the quality of evidence and a group consensus process to determine final recommendations and grade their strength (conditional or strong). Good practice statements were agreed upon when indirect evidence was sufficiently compelling that a formal vote was unnecessary. Results This American College of Rheumatology guideline provides 12 ungraded good practice statements and 131 graded recommendations for reproductive health care in RMD patients. These recommendations are intended to guide care for all patients with RMD, except where indicated as being specific for patients with systemic lupus erythematosus, those positive for antiphospholipid antibody, and/or those positive for anti‐Ro/SSA and/or anti‐La/SSB antibodies. Recommendations and good practice statements support several guiding principles: use of safe and effective contraception to prevent unplanned pregnancy, pre‐pregnancy counseling to encourage conception during periods of disease quiescence and while receiving pregnancy‐compatible medications, and ongoing physician‐patient discussion with obstetrics/gynecology collaboration for all reproductive health issues, given the overall low level of available evidence that relates specifically to RMD. Conclusion This guideline provides evidence‐based recommendations developed and reviewed by panels of experts and RMD patients. Many recommendations are conditional, reflecting a lack of data or low‐level data. We intend that this guideline be used to inform a shared decision‐making process between patients and their physicians on issues related to reproductive health that incorporates patients’ values, preferences, and comorbidities.

show abstract

Section: Results/recommendationsmentioning

confidence: 99%

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

Sammaritano

Bermas

Chakravarty

et al. 2020

Arthritis & Rheumatology

437

520

View full text Add to dashboard Cite

show abstract

“…Conventional DMARDs that can be continued during pregnancy include hydroxychloroquine, sulfasalazine, azathioprine and the calcineurin inhibitors ciclosporin and tacrolimus 7,9 . Women who have conceived while being treated with leflunomide and then stopped this drug and undergone cholestyramine washout in the first trimester 90,93 , or who have been exposed to leflunomide at various stages of pregnancy without washout 94,95 , do not have an increased risk of APOs. Although leflunomide does not seem to be a major human teratogen, more data are required before its use during pregnancy can be safely advised.…”

Section: [H1] Medicationmentioning

confidence: 99%

Stratifying management of rheumatic disease for pregnancy and breastfeeding

2019

View full text Add to dashboard Cite

The management of inflammatory rheumatic diseases during pregnancy and breastfeeding has undergone considerable change in the past few years. Modern therapeutics, including biologic and targeted synthetic DMARDs, have enabled substantial improvements in control of rheumatic diseases, resulting in more patients with severe disease considering pregnancy. Therefore, management of disease for these patients needs to be discussed with clinicians before, during and after pregnancy and patients need to know what complications they might experience before they become pregnant. This Review will summarize the effects pregnancy has on various rheumatic diseases and the effects these diseases have on pregnancy, as well as provide advice regarding the alteration and monitoring of therapy before, during and after pregnancy. Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

show abstract

“…In most cases, however, wash-out procedures with cholestyramine had been carried out [34–36]. For this reason, these definitely promising data have not yet resulted in a modified assessment of LEF with respect to its application in pregnancy.…”

Section: Immunosuppressives and Disease-modifying Antirheumatic Drugsmentioning

confidence: 99%

Immunosuppressives and biologics during pregnancy and lactation

Puchner

Gröchenig

Sautner

et al. 2019

Wien Klin Wochenschr

View full text Add to dashboard Cite

SummaryAn increasing and early-onset use of immunosuppressives and biologics has become more frequently seen among patients with inflammatory bowel diseases (IBD) and rheumatic disorders. Many women in their childbearing years currently receive such medications, and some of them in an interdisciplinary setting. Many questions arise in women already pregnant or wishing to conceive with respect to continuing or discontinuing treatment, the risks borne by the newborns and their mothers and long-term safety. Together with the Austrian Society of Rheumatology and Rehabilitation, the IBD working group of the Austrian Society of Gastroenterology and Hepatology has elaborated consensus statements on the use of immunosuppressives and biologics in pregnancy and lactation. This is the first Austrian interdisciplinary consensus on this topic. It is intended to serve as a basis and support for providing advice to our patients and their treating physicians.

show abstract

Leflunomide use during pregnancy and the risk of adverse pregnancy outcomes

Cited by 43 publications

References 35 publications

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

Stratifying management of rheumatic disease for pregnancy and breastfeeding

Immunosuppressives and biologics during pregnancy and lactation

Contact Info

Product

Resources

About