Updated pharmacological management of rheumatoid arthritis for women before, during, and after pregnancy, reflecting recent guidelines

Murray, Kieran; Moore, L.A.; O’Brien, Ciara; Clohessy, Anne; Brophy, Caroline; Minnock, Patricia; FitzGerald, Oliver; Molloy, Eamonn; Mongey, Anne‐Barbara; Higgins, Shane; Higgins, Mary; Auliffe, Fionnuala Mc; Veale, Douglas J.

doi:10.1007/s11845-018-1829-7

Cited by 12 publications

(13 citation statements)

References 9 publications

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“…In one study of methotrexate monotherapy in PsA, < 20% of patients achieved minimal disease activity at 6 months [71]. Adverse effects include nausea, headaches, cytopenia, hepatotoxicity, pulmonary toxicity and teratogenicity [72][73][74][75]. Blood monitoring is burdensome.…”

Section: Discussionmentioning

confidence: 99%

Long-term remission and biologic persistence rates: 12-year real-world data

et al. 2021

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Background Biologic therapies have greatly improved outcomes in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Yet, our ability to predict long-term remission and persistence or continuation of therapy remains limited. This study explores predictors of remission and persistence of the initial biologic therapy in patients after 12 years. Furthermore, outcomes with adalimumab and etanercept are compared. Patients and methods RA and PsA patients were prospectively recruited from a biologic clinic. Outcomes on commencing therapy, at 1 year and 12 years were reviewed. Demographics, medications, morning stiffness, patient global health score, tender and swollen joint counts, antibody status, CRP and HAQ were collected. Outcomes at 1 year and 12 years are reported and predictors of biologic persistence and EULAR-defined remission (DAS28-CRP < 2.6) are examined with univariate and multivariate analysis. Results A total of 403 patients (274 RA and 129 PsA) were analysed. PsA patients were more likely to be male, in full-time employment and have completed higher education. PsA had higher remission rates than RA at both 1 year (60.3% versus 34.5%, p < 0.001) and 12 years (91.3% versus 60.6%, p < 0.001). This difference persisted when patients were matched for baseline disease activity (p < 0.001). Biologic continuation rates were high for RA and PsA at 1 year (49.6% versus 58.9%) and 12 years (38.2% versus 52.3%). In PsA, patients starting on etanercept had lower CRP at 12 years (p = 0.041). Multivariate analysis showed 1-year continuation [OR 4.28 (1.28–14.38)] and 1-year low-disease activity [OR 3.90 (95% CI 1.05–14.53)] was predictive of a 12-year persistence. Persistence with initial biologic at 12 years [OR 4.98 (95% CI 1.83–13.56)] and male gender [OR 4.48 (95% CI 1.25–16.01)] predicted 12 year remission. Conclusions This is the first study to show better response to biologic therapy in PsA compared to RA at 12 years. Long-term persistence with initial biologic agent was high and was predicted by biologic persistence and low-disease activity at 1 year. Interestingly, PsA patients had higher levels of employment, educational attainment, and long-term remission rates compared to RA patients.

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Section: Discussionmentioning

confidence: 99%

Long-term remission and biologic persistence rates: 12-year real-world data

et al. 2021

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“…In this case, the risk can be three times higher [ 128 ]. Current recommendations regarding the use of biologics during pregnancy advise the discontinuation of medication at 20 weeks of gestation for infliximab and adalimumab and around 32 weeks for etanercept [ 132 ]. If the medication is continued beyond 28 weeks, the drug levels in the fetus will exceed those in the mother, and precautions and close monitoring are required after birth.…”

Section: Pathological Transfer Of Igg—biological Therapy In Pregnamentioning

confidence: 99%

Benefits and Risks of IgG Transplacental Transfer

et al. 2020

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Maternal passage of immunoglobulin G (IgG) is an important passive mechanism for protecting the infant while the neonatal immune system is still immature and ineffective. IgG is the only antibody class capable of crossing the histological layers of the placenta by attaching to the neonatal Fc receptor expressed at the level of syncytiotrophoblasts, and it offers protection against neonatal infectious pathogens. In pregnant women with autoimmune or alloimmune disorders, or in those requiring certain types of biological therapy, transplacental passage of abnormal antibodies may cause fetal or neonatal harm. In this review, we will discuss the physiological mechanisms and benefits of transplacental transfer of maternal antibodies as well as pathological maternal situations where this system is hijacked, potentially leading to adverse neonatal outcomes.

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“…Twenty studies, including 3114 urolithiasis patients and 3174 controls, evaluated the FokI polymorphism. Of which, 14 studies were conducted in Asian countries [ 26 , 28 , 34 , 35 , 37 , 40 – 42 , 44 , 50 , 60 – 63 ] and 6 studies were in European countries [ 31 – 33 , 48 , 64 , 65 ]. Overall, no significant association was detected between FokI SNP and urolithiasis risk under all five genetic models.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-two case-control studies with 4188 cases and 3955 controls met inclusion criteria for evaluating the association between TaqI SNP and urolithiasis risk. Among them, ten studies were performed in Asian population [ 28 , 40 – 42 , 44 , 60 – 63 , 66 ] and eleven studies were in European population [ 29 , 31 , 36 , 38 , 39 , 45 , 46 , 48 , 65 , 67 ] and one study in the USA [ 24 ]. The pooled results did not indicate significant association between TaqI SNP and urolithiasis risk except in tt vs. TT model (OR = 1.27, 95% CI = 1.01–1.59, P = 0.04), also subgroup analysis revealed that the tt genotype was associated with urolithiasis risk in Caucasians when compared with the TT genotype [tt vs. TT (OR = 1.30, 95% CI = 1.021–1.65, P = 0.03)], Fig.…”

Section: Resultsmentioning

confidence: 99%

Vitamin D receptor gene polymorphisms and susceptibility to urolithiasis: a meta-regression and meta-analysis

et al. 2020

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Background The currently available data with respect to the association between vitamin D receptor ( VDR ) gene polymorphism and risk to urolithiasis are inconclusive and inconsistent. Hence, an exhaustive meta-analysis can solve the discrepancies and provide a hint for upcoming investigations. Herein, a meta-analysis was carried out to attain a conclusive estimate of the association between VDR gene single nucleotide polymorphisms (SNPs) and urolithiasis risk. Methods The major databases, including ISI Web of science, Scopus, and PubMed/MEDLINE were searched systematically from until June 2020 to retrieve all relevant studies. Association between VDR gene polymorphisms, including FokI (rs2228570), TaqI (rs731236), BsmI (rs1544410), and ApaI (rs7975232), and urolithiasis risk was evaluated using pooled odds ratio (OR) and their corresponding 95% confidence interval (CI). Additionally, to seek for the potential source of heterogeneity, meta-regression analyses were exerted. Results Literature search led to finally finding of 33 studies evaluating the VDR gene SNPs and urolithiasis risk. It was observed that none of the four SNPs were significantly associated with urolithiasis predisposition. However, subgroup analysis confirmed higher risk of urolithiasis in East-Asian and Caucasian population with ApaI and TaqI gene polymorphism. The analyses of sensitivity acknowledged the results stability. Conclusion Although this meta-analysis did not support the association of FokI, TaqI, BsmI , and ApaI in the overall polled analysis, it suggests that ApaI and TaqI SNPs is associated with increased risk of urolithiasis in East-Asian and Caucasians populations.

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Updated pharmacological management of rheumatoid arthritis for women before, during, and after pregnancy, reflecting recent guidelines

Cited by 12 publications

References 9 publications

Long-term remission and biologic persistence rates: 12-year real-world data

Long-term remission and biologic persistence rates: 12-year real-world data

Benefits and Risks of IgG Transplacental Transfer

Vitamin D receptor gene polymorphisms and susceptibility to urolithiasis: a meta-regression and meta-analysis

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