Anti-TNFs in Pregnancy Study Advises Continued Caution

The only way to definitively address the question of risk associated with anti-TNFs and pregnancy would be to conduct a randomized controlled trial, according to Dr. Deborah P. M. Symmons.

There are, however, a few problems with that strategy. "Clearly, this would be very difficult to design, would need to be very large, and is never going to happen!" she joked.

"Beyond that, we have to wait for anecdotal evidence to accumulate."

In the meantime, she said, "We advise all patients with rheumatoid arthritis to discuss a planned pregnancy with their rheumatologist prior to conception in order to make prospective plans about what to do about treatment.

"There are a number of other antirheumatic drugs, for example methotrexate and leflunomide, which carry a substantially higher risk than has been seen with anti-TNF therapy so far. However, many patients on anti-TNFs take them with another anti-rheumatic drug."

According to Dr. Symmons, when treating a female patient of child-bearing age, "I would share what is currently known about the risks and benefits of continuing anti-TNF therapy with the woman with RA and let her ask further questions and make up her own mind about what to do.

"This study is reassuring for us to continue our current practice."

Dr. Symmons is one of the authors of the current study as well as a professor of rheumatology and musculoskeletal epidemiology at the University of Manchester, in the UK. She had no financial interests to disclose.