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REVIEW ARTICLE
Year : 2016  |  Volume : 11  |  Issue : 6  |  Page : 156-162

Nonbiologic disease-modifying antirheumatic drugs in pregnancy


Department of Clinical Immunology, JIPMER, Puducherry, India

Correspondence Address:
Durga Prasanna Misra
Department of Clinical Immunology, JIPMER, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-3698.194551

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Rheumatic disease often affects young females and males in the reproductive age group. Management of these diseases with immunosuppressive disease-modifying antirheumatic drugs (DMARDs) is fraught with potential risks for the developing fetus as well as adverse pregnancy outcomes. In developing countries like India, most patients are treated with conventional DMARDs. We reviewed recent literature on safety during pregnancy for conventional disease-modifying agents, in view of the recently published landmark guidelines of the British Society for Rheumatology and the European League against Rheumatism. Exposure to leflunomide and cyclophosphamide is contraindicated in mothers during pregnancy and preconception phase, and fathers during conception due to risks for the developing fetus. Maternal exposure to methotrexate (MTX) during pregnancy or preconception confers higher risk of adverse pregnancy and fetal outcomes although paternal exposure may not be harmful. Sulfasalazine is safe during pregnancy; however, paternal exposure may reduce fertility, but this is reversible with cessation of the drug. Hydroxychloroquine, azathioprine, cyclosporine, and tacrolimus are compatible with maternal and paternal exposures without evidence for increased risk to the developing fetus. Insufficient data exist regarding safety profile of tofacitinib and apremilast during pregnancy. Rheumatologists should be cautious while starting these drugs in women and men of reproductive age group, and counsel patients accordingly to minimize the risk of adverse fetomaternal outcomes.


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