Research Center, CHU Sainte Justine, 3175, Chemin de la Côte‑Sainte‑Catherine, Montreal, QC, H3T 1C5, Canada.
Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada.
BMC Pregnancy Childbirth. 2024 Nov 19;24(1):765. doi: 10.1186/s12884-024-06932-y.
The medications used for autoimmune diseases have significantly evolved in recent years, but there is limited knowledge about how treatment practices changed during pregnancy. This study aimed to describe the temporal trends of immunosuppressants, immunomodulators and biologics use during pregnancy among women with autoimmune diseases, compare their use before, during, and after pregnancy, and identify factors predicting the discontinuation of these medications during pregnancy.
Using data from the Quebec Pregnancy Cohort (1998-2015), which included women under the RAMQ prescription drug plan for at least 12 months before and after pregnancy, the analysis focused on those with at least one International Classification of Diseases Ninth or Tenth Revision code in the year before pregnancy for inflammatory bowel disease, rheumatoid arthritis, spondylarthropathies, connective tissue diseases, systemic lupus erythematosus, or vasculitis. Exposure to immunosuppressants, immunomodulators and biologics were evaluated before and during the pregnancy. Discontinuation during pregnancy was defined as having no prescriptions filled during pregnancy or overlapping with the first day of gestation (1DG), given that at least one prescription was filled in the year prior to pregnancy. Generalized estimating equations were applied to estimate adjusted odds ratios (aOR) for predicting medication discontinuation during pregnancy.
Among 441,570 pregnant women, 3,285 had autoimmune diseases. From 1998 to 2014, the use of immunomodulators increased from 3.7% to 11.9%, immunosuppressants from 4.1% to 13.7%, and biologics from 0% to 15.6%. During pregnancy, compared to before, there was a significant decrease in exposure to immunomodulators (8.6% to 5.4%), immunosuppressants (14.2% to 8.7%), and biologics (5.1% to 4.7%). Factors influencing discontinuation varied by medication type; for immunosuppressants, prior biologics use (aOR = 2.12, 95%CI 1.16-3.85) and the year of pregnancy (aOR = 0.93, 95%CI 0.89-0.98) were key factors, while for biologics, it was only the year of pregnancy (aOR = 0.68, 95%CI 0.54-0.86).
The use of immunomodulators, immunosuppressants, and biologics has increased over time. However, exposure during pregnancy decreased, with recent years showing a lower rate of discontinuation. Understanding the factors influencing medication discontinuation during pregnancy can improve management strategies for women with autoimmune diseases.
近年来，用于治疗自身免疫性疾病的药物有了显著的发展，但对于怀孕期间治疗方法的变化知之甚少。本研究旨在描述患有自身免疫性疾病的女性在怀孕期间使用免疫抑制剂、免疫调节剂和生物制剂的时间趋势，比较其在怀孕前、怀孕期间和怀孕后的使用情况，并确定预测这些药物在怀孕期间停药的因素。
利用魁北克妊娠队列（1998-2015 年）的数据，该队列包括至少在怀孕前和怀孕后 12 个月内接受 RAMQ 处方药计划的女性，分析重点是那些在怀孕前一年至少有一个国际疾病分类第 9 或第 10 版代码的女性，这些代码用于炎症性肠病、类风湿性关节炎、脊柱关节病、结缔组织疾病、系统性红斑狼疮或血管炎。在怀孕前和怀孕期间评估免疫抑制剂、免疫调节剂和生物制剂的使用情况。怀孕期间停药的定义是在怀孕期间没有开处方或与妊娠第 1 天（1DG）重叠，因为在怀孕前一年至少有一个处方。应用广义估计方程来估计预测怀孕期间药物停药的调整优势比（aOR）。
在 441570 名孕妇中，有 3285 名患有自身免疫性疾病。从 1998 年到 2014 年，免疫调节剂的使用率从 3.7%增加到 11.9%，免疫抑制剂从 4.1%增加到 13.7%，生物制剂从 0%增加到 15.6%。与怀孕前相比，怀孕期间免疫调节剂（8.6%降至 5.4%）、免疫抑制剂（14.2%降至 8.7%）和生物制剂（5.1%降至 4.7%）的使用显著减少。影响停药的因素因药物类型而异；对于免疫抑制剂，先前使用生物制剂（aOR=2.12，95%CI 1.16-3.85）和妊娠年份（aOR=0.93，95%CI 0.89-0.98）是关键因素，而对于生物制剂，唯一的因素是妊娠年份（aOR=0.68，95%CI 0.54-0.86）。
免疫调节剂、免疫抑制剂和生物制剂的使用随着时间的推移而增加。然而，怀孕期间的暴露量下降，近年来停药率较低。了解怀孕期间药物停药的影响因素可以改善患有自身免疫性疾病的女性的管理策略。
