Therapy with immunosuppressive drugs and biological agents and use of contraception in patients with rheumatic disease.

OBJECTIVE

To investigate the attitude of patients towards immunosuppressive and biological drugs in relation to reproduction and the outcome of pregnancies exposed to these drugs.

METHODS

We performed 2 postal surveys in regard to immunosuppressive drugs and reproduction, one in patients with rheumatic disease, the second in Swiss rheumatologists.

RESULTS

Among the 237 female patients and the 189 male patients contacted for the survey, 72% of women and 40% of men returned the questionnaire. Ninety-four women and 47 men had received one or several immunosuppressive or biological agents during the years 2000-2005. Correct advice in regard to drugs and necessary birth control had been given to 84% of women. Advice to men was more inconsistent. One-third of women and 50% of men treated with potentially teratogenic drugs methotrexate (MTX) or leflunomide had not practiced birth control. The surveys of rheumatologists and patients disclosed 66 pregnancies under therapy with immunosuppressive and biological drugs with successful outcomes in 73%. However, 20% of pregnancies in women occurred under treatment with MTX and leflunomide.

CONCLUSION

Issues regarding drugs and reproduction are not always sufficiently discussed with female and male patients. The increasing use of combination therapies containing MTX necessitates ensuring that advice regarding birth control is followed in order to avoid pregnancies exposed to potentially fetotoxic drugs.