Chin Athena, Terrett Alice, Kwon Mihye, Whittle Samuel, Hill Catherine
Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia, and Flinders Medical Centre, Bedford Park, South Australia, Australia.
Royal Adelaide Hospital, Adelaide, South Australia, Australia, Flinders Medical Centre, Bedford Park, South Australia, Australia, and The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
Arthritis Care Res (Hoboken). 2025 Apr 21. doi: 10.1002/acr.25558.
Autoimmune rheumatic diseases commonly affect individuals of childbearing age, with historically increased adverse pregnancy outcomes in this group. The advent of disease-modifying antirheumatic drugs (DMARDs) has fostered more suitable conditions for pregnancy; however, this is accompanied by challenges in ensuring safe use in reproductive health. The aim of this review is to compare existing guideline recommendations for the use of DMARDs in pregnancy and reproductive health for patients with rheumatic disease.
A scoping review was performed with Medline and Embase, in addition to a hand search, to identify guidelines published since 2014 by academic societies in rheumatology that addressed the management of DMARDs in pregnancy in any of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and systemic lupus erythematosus. Conventional synthetic DMARDs (csDMARDs) (methotrexate, sulfasalazine, leflunomide, and hydroxychloroquine), biologic DMARDs (bDMARDs) (adalimumab, etanercept, infliximab, golimumab, certolizumab, abatacept, tocilizumab, rituximab, and anakinra), and targeted synthetic DMARDs (tsDMARDs) (tofacitinib, baricitinib, and upadacitinib) were targeted. Two authors performed data extraction in duplicate (AC, AT).
A total of 18 guidelines were included. Recommendations for DMARD use in preconception were present in 10 guidelines (56%), lactation in 12 guidelines (67%), and male fertility in 6 guidelines (33%). A total of 13 guidelines (72%) included recommendations for csDMARDs, 13 guidelines (72%) included recommendations for bDMARDs, and 5 guidelines (28%) included recommendations for tsDMARDs. There was moderate evidence supporting relatively uniform csDMARD recommendations, compared to minimal evidence for bDMARD and tsDMARD use with variable recommendations.
There is heterogeneity in the formulation of guidelines on the use of DMARDs in pregnancy. Recommendations for csDMARDs were similar between guidelines. There was significant variability in recommendations for bDMARD and tsDMARD use, reflecting current minimal literature in this area.
自身免疫性风湿性疾病通常影响育龄期个体，历史上该群体的不良妊娠结局有所增加。改善病情抗风湿药（DMARDs）的出现为妊娠创造了更适宜的条件；然而，这伴随着确保其在生殖健康中安全使用的挑战。本综述的目的是比较现有关于风湿性疾病患者在妊娠和生殖健康中使用DMARDs的指南建议。
除手工检索外，还对Medline和Embase进行了范围综述，以识别自2014年以来风湿病学术协会发布的指南，这些指南涉及类风湿关节炎、强直性脊柱炎、银屑病关节炎和系统性红斑狼疮中任何一种疾病在妊娠期间DMARDs的管理。目标药物包括传统合成DMARDs（csDMARDs）（甲氨蝶呤、柳氮磺吡啶、来氟米特和羟氯喹）、生物DMARDs（bDMARDs）（阿达木单抗、依那西普、英夫利昔单抗、戈利木单抗、赛妥珠单抗、阿巴西普、托珠单抗、利妥昔单抗和阿那白滞素）以及靶向合成DMARDs（tsDMARDs）（托法替布、巴瑞替尼和乌帕替尼）。两名作者进行了重复的数据提取（AC，AT）。
共纳入18项指南。10项指南（56%）中有关于孕前使用DMARDs的建议，12项指南（67%）中有关于哺乳期使用的建议，6项指南（33%）中有关于男性生育力的建议。共有13项指南（72%）包括csDMARDs的建议，13项指南（72%）包括bDMARDs的建议，5项指南（28%）包括tsDMARDs的建议。与bDMARDs和tsDMARDs使用的建议证据极少且各不相同相比，有中等证据支持相对统一的csDMARDs建议。
关于妊娠期间使用DMARDs的指南制定存在异质性。各指南中csDMARDs的建议相似。bDMARDs和tsDMARDs使用的建议存在显著差异，反映了该领域目前的文献极少。
