Continuous use of TNFi on the rise in pregnant women

A trend toward increased continuous use of tumour necrosis factor inhibitors has been observed throughout gestation, which suggests growing confidence in the safety and effectiveness of this medication during pregnancy, reveals a study.

Using the MarketScan commercial claims database, researchers analysed pregnancies resulting in a liver birth among women with rheumatoid arthritis (RA), radiographic axial spondyloarthritis (r-axSpA), psoriatic arthritis (PsA), psoriasis, and /or inflammatory bowel disease (IBD) aged 15‒45 years, who were hospitalized for delivery between January 2011 and December 2021.

TNFi exposure was defined as one or more filled prescriptions or infusion procedure claims for a TNFi. Researchers categorized the timing of exposure by the gestational period and specific trimesters, with a grace period of 5 half-lives added to each prescription to account for ongoing biological activity.

A total of 3,711 pregnancies exposed to TNFi among 49,925 women with RA, r-axSpA, PsA, psoriasis, and/or IBD were included in the analysis. Of the pregnancies, 64 percent had continuous TNFi use throughout all three trimesters.

The majority of TNFi-exposed pregnancies (89 percent) had preconception exposure, and 68 percent of the women continued using TNFi postpartum. An increase was observed in the proportion of pregnancies with TNFi exposure throughout all trimesters, rising from 55 percent in 2011‒2013 to 73 percent in 2020‒2021 (p<0.001 for trend).

The use of corticosteroids during pregnancy/postpartum was less frequent in pregnancies with TNFi exposure throughout gestation compared with those exposed in the first or second trimester only.