类风湿关节炎患者孕期用药模式。

Patterns of medication use during pregnancy in rheumatoid arthritis.

机构信息

Harvard School of Public Health, Boston, Massachusetts, USA.

出版信息

Arthritis Care Res (Hoboken). 2011 May;63(5):721-8. doi: 10.1002/acr.20422.

DOI:10.1002/acr.20422

PMID:21557526

Abstract

OBJECTIVE

To characterize therapies prescribed during pregnancy to women with rheumatoid arthritis (RA).

METHODS

We conducted a cohort study of women with RA with pregnancies using health care utilization data from 2002-2008. We examined the distribution of RA drugs by therapeutic classes, including nonsteroidal antiinflammatory drugs (NSAIDs)/coxibs, glucocorticoids, nonbiologic disease-modifying antirheumatic drugs (DMARDs), and biologic DMARDs, during 90-day pregnancy trimesters and the 180 days prior to pregnancy. Drugs were characterized according to the Food and Drug Administration risk classification system. Differences in exposure by period were determined by chi-square tests.

RESULTS

A total of 393 pregnancies were identified among 34,169 women with RA. Seventy-two percent of pregnancies ended in a delivery. Approximately 24% of women with RA received a DMARD during preconception. At any point during pregnancy, 23% of women with deliveries were dispensed ≥1 DMARD and the proportion of use declined from the first to the third trimester (P = 0.03). Similar to DMARD therapy, use of NSAIDs/coxibs and exposure to category D/X medications were significantly lower compared to prepregnancy use (P < 0.05). In contrast, more women were prescribed glucocorticoids during pregnancy than before pregnancy. Use of biologics occurred in 12.5% of pregnancies. Compared to women with deliveries, women who experienced abortions were more frequently exposed to NSAIDs/coxibs (P < 0.05). Dispensing of category D/X medications was also higher in women with spontaneous abortions and primarily involved methotrexate (P < 0.05).

CONCLUSION

Approximately 24% of women with RA received a DMARD in the 180 days before conception, and the proportion dropped during pregnancy. Glucocorticoid use remained high throughout pregnancy. Our results suggest that continued efforts directed at counseling women and their physicians about the potential risks/benefits of RA therapies during pregnancy are warranted.

摘要

目的

描述类风湿关节炎（RA）女性患者孕期的治疗方案。

方法

我们利用 2002-2008 年的医疗保健利用数据，对 RA 伴妊娠的女性进行了队列研究。我们研究了 90 天孕期和妊娠前 180 天的 RA 药物的分布情况，包括非甾体抗炎药（NSAIDs）/coxibs、糖皮质激素、非生物改善病情抗风湿药（DMARDs）和生物 DMARDs，按照美国食品药品监督管理局（FDA）风险分类系统对药物进行分类。通过卡方检验确定不同时期的暴露差异。

结果

共确定了 34169 例 RA 女性中的 393 例妊娠。72%的妊娠以分娩结束。大约 24%的 RA 女性在受孕前接受了 DMARD 治疗。在任何妊娠阶段，有 23%分娩的女性至少接受了 1 种 DMARD 治疗，而且从第一孕期到第三孕期，使用比例下降（P=0.03）。与 DMARD 治疗相似，NSAIDs/coxibs 和 D/X 类药物的使用显著低于受孕前（P<0.05）。相比之下，怀孕期间有更多女性接受了糖皮质激素治疗。在 12.5%的妊娠中使用了生物制剂。与分娩的女性相比，流产的女性更频繁地暴露于 NSAIDs/coxibs（P<0.05）。流产的女性中，D/X 类药物的使用也更高，主要涉及甲氨蝶呤（P<0.05）。