Drug adherence low in pregnant women with RA

Women with rheumatoid arthritis (RA) appear to have low utilization of medications safe to take during pregnancy, commonly discontinuing their medications in the first trimester, a recent study has found.

The study used population-based administrative data and included 1,730 singleton pregnancies in 1,301 women with RA (mean age at delivery, 31.4 years). Researchers evaluated the utilization of RA medications, such as conventional synthetic disease modifying antirheumatic drugs (csDMARDs), biologics, glucocorticosteroids (GCs) and nonsteroidal anti-inflammatory drugs (NSAIDs) during 24 and 12 months prior to conception, each trimester of pregnancy, and 12 months after delivery.

With regard to medication use, the most frequently used csDMARDs throughout the perinatal period were antimalarials (20.8 percent before conception, 7.8 percent during pregnancy and 13.1 percent postpartum) and sulfasalazine (8.4 percent, 2.3 percent and 4.6 percent). Methotrexate was the second most frequently used csDMARD before conception (10.9 percent), but this dropped to <1 percent during pregnancy.

Use of ciclosporin, gold, leflunomide and minocycline prior to conception was also low at 0.6 percent, 2.8 percent, 1.0 percent and 2.4 percent, respectively, with a further decline during pregnancy. Biologics used were predominantly antitumour necrosis factor inhibitors (anti-TNFs; 4.3 percent prior to conception, 1.9 percent during pregnancy and 4.5 percent postpartum). Pattern of use was similar for GCs and NSAIDs.

The rate of medication discontinuation was high in the first trimester of pregnancy, particularly that of antimalarials (57.3 percent), azathioprine (59.1 percent), sulfasalazine (69.5 percent) and biologics (50.8 percent).

Factors associated with discontinuation of antimalarials in the first trimester included maternal age (odds ratio [OR], 0.90, 95 percent confidence interval [CI], 0.86–0.95) and number of rheumatology visits (OR, 0.86, 95 percent CI, 0.75–0.97). On the other hand, biologics discontinuation was associated with prior adverse birth outcome (OR, 0.22, 95 percent CI, 0.05–0.95).

The present data highlight a potential gap in care of pregnant women with RA, according to the researchers. “With growing guidance on the management of pregnancies in RA, it is important to ensure translation of clinical knowledge to women who are making important medication-taking decisions during pregnancy.”