RA drugs during pregnancy don't increase infection risk in child

Rheumatoid arthritis drugs, that may cause immunosuppression, taken by women during pregnancy, their children do not have a marked excess risk of developing serious infections, according to a new research.

Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body.

Evelyne Vinet and his associates conducted a study to investigate whether tumor necrosis factor inhibitors (TNFis), which are used to treat RA and are transported across the placenta, may cause immunosuppression and compromise young children's ability to fight infections.

2,989 offspring of women with rheumatoid arthritis were included in the study and compared with a randomly selected 14,596 control group of children. Researchers defined TNFi exposure based on at least one filled prescription during pregnancy. Children were followed from birth until 12 months of age

The study found that among offspring of women with RA, 380 (12.7 percent) were exposed to TNFis during pregnancy. The percent of serious infections in those with no TNFi exposure was similar (2.0 percent) to control offspring (1.9 percent), while the percent of serious infections in offspring with TNFi exposure was 3.2 percent.

"Within the largest cohort of RA offspring exposed to TNFis ever assembled, we did not observe a marked excess risk for serious infections versus unexposed RA offspring and children from the general population. Our data are potentially reassuring, however, we could not exclude a differential risk according to specific TNFi characteristics, with infliximab potentially resulting in a 3-fold increase in the risk of serious infections compared with other TNFis," said Dr. Vinet

The European League Against Rheumatism recommends discontinuing infliximab and adalimumab before 20 weeks of gestation and etanercept before 31 to 32 weeks to minimize the risk of infections in offspring, while certolizumab can be continued throughout pregnancy.

Dr. Vinet said that the study provides new evidence to counsel RA women contemplating pregnancy.

The study feels that more research has to be done in this aspect on a broader scope before drawing a suitable conclusion.

It was published in the journal The Arthritis and Rheumatology.