2026-04-17T07:41:05Zhttps://recercat.cat/oai/request

oai:recercat.cat:11351/136642025-10-24T10:39:42Zcom_2072_378070com_2072_378040col_2072_378092

EULAR recommendations for use of antirheumatic drugs in reproduction, pregnancy, and lactation: 2024 update Rüegg, Linda Pluma Sanjurjo, Andrea HAMROUN, SABRINA Cecchi, Irene Perez, Luis Anderson, Philip Embaràs Alletament Reproducció Reumatisme - Tractament Antireumàtics - Ús terapèutic DISEASES::Musculoskeletal Diseases::Rheumatic Diseases Other subheadings::Other subheadings::Other subheadings::/drug therapy PHENOMENA AND PROCESSES::Reproductive and Urinary Physiological Phenomena::Reproductive Physiological Phenomena::Reproduction PHENOMENA AND PROCESSES::Reproductive and Urinary Physiological Phenomena::Reproductive Physiological Phenomena::Reproduction::Pregnancy PHENOMENA AND PROCESSES::Reproductive and Urinary Physiological Phenomena::Reproductive Physiological Phenomena::Lactation CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Antirheumatic Agents Other subheadings::Other subheadings::/therapeutic use ENFERMEDADES::enfermedades musculoesqueléticas::enfermedades reumáticas Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia FENÓMENOS Y PROCESOS::fenómenos fisiológicos reproductivos y urinarios::fenómenos fisiológicos de la reproducción::reproducción FENÓMENOS Y PROCESOS::fenómenos fisiológicos reproductivos y urinarios::fenómenos fisiológicos de la reproducción::reproducción::embarazo FENÓMENOS Y PROCESOS::fenómenos fisiológicos reproductivos y urinarios::fenómenos fisiológicos de la reproducción::lactancia COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antirreumáticos Otros calificadores::Otros calificadores::/uso terapéutico Antirheumatic drugs; Reproduction; Pregnancy Medicamentos antirreumáticos; Reproducción; Embarazo Medicaments antireumàtics; Reproducció; Embaràs Objectives To update the existing European Alliance of Associations for Rheumatology (EULAR) points to consider (PtC) for use of antirheumatic drugs in reproduction, pregnancy, and lactation, including additional drugs and adverse outcomes as well as paternal drug safety. Methods According to the EULAR standardised operating procedures, an international task force (TF) defined the questions for a systematic literature review, followed by formulation of the updated statements. A predefined voting process was applied to each overarching principle and statement. Level of evidence and strength of recommendation were assigned, and participants finally provided their level of agreement for each item. Results The TF proposes 5 overarching principles and 12 recommendations for the use of antirheumatic drugs before and during pregnancy, through lactation, and in male patients. The current evidence indicates that synthetic disease-modifying antirheumatic drugs (DMARDs) compatible with pregnancy include antimalarials, azathioprine, colchicine, cyclosporine, sulfasalazine, and tacrolimus. Regarding nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids, a more restrictive approach to their use during pregnancy is recommended. Based on an individualised risk-benefit assessment, all tumour necrosis factor inhibitor (TNFi) biologic DMARDs (bDMARDs) can be used throughout pregnancy, and non-TNFi bDMARDs may be used if needed. In relation to lactation, compatible drugs include antimalarials, azathioprine, colchicine, cyclosporine, glucocorticoids, intravenous immunoglobulin (IVIG), NSAIDs, sulfasalazine, and tacrolimus. All bDMARDs are considered compatible with breastfeeding. Concerning the use of drugs in men, compatible options include antimalarials, azathioprine, colchicine, cyclosporine, IVIG, leflunomide, methotrexate, mycophenolate, NSAIDs, glucocorticoids, sildenafil, sulfasalazine, tacrolimus, and bDMARDs. Conclusions The updated recommendations provide consensus guidance and will help to improve the quality of care of patients during the phases of reproduction, pregnancy, and lactation. This work was supported by the European League Against Rheumatism as project QoC012. 2025-10-24T10:39:42Z 2025-10-24T10:39:42Z 2025-10-24T10:39:42Z 2025-09-16T11:44:05Z 2025-09-16T11:44:05Z 2025-06 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://hdl.handle.net/11351/13664 Annals of the Rheumatic Diseases;84(6) https://doi.org/10.1016/j.ard.2025.02.023 Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess Elsevier Scientia