dc.contributor
Institut Català de la Salut
dc.contributor
[Pluma A] Servei de Reumatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Hamroun S] Department of Rheumatology, Pontoise Hospital, Pontoise, Paris, France. [Rüegg L] Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Switzerland. [Cecchi I] University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERNReconnect, and RITA-ERN Member) with Nephrology and Dialysis Unit, University of Turin, Turin, Italy. Center of ImmunoRheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Turin, Italy. Department of Clinical and Biological Sciences, University of Turin, Turin, Italy. [Kramer M] Epidemiology and Health Services Research, German Rheumatology Research Center, Berlin, Germany. [Perez-Garcia LF] Department of Rheumatology, Erasmus University Medical Center, Rotterdam, Netherlands
dc.contributor
Vall d'Hebron Barcelona Hospital Campus
dc.contributor.author
Rüegg, Linda
dc.contributor.author
Kramer, Malte
dc.contributor.author
Pluma Sanjurjo, Andrea
dc.contributor.author
HAMROUN, SABRINA
dc.contributor.author
Cecchi, Irene
dc.contributor.author
Perez, Luis
dc.date.accessioned
2025-11-01T20:07:37Z
dc.date.available
2025-11-01T20:07:37Z
dc.date.issued
2025-10-31T07:30:55Z
dc.date.issued
2025-10-31T07:30:55Z
dc.identifier
Pluma A, Hamroun S, Rüegg L, Cecchi I, Kramer M, Perez-Garcia LF, et al. Antirheumatic drugs in reproduction, pregnancy, and lactation: a systematic literature review informing the 2024 update of the EULAR recommendations. Ann Rheum Dis. 2025 Sep;84(9):1561–90.
dc.identifier
http://hdl.handle.net/11351/13990
dc.identifier
10.1016/j.ard.2025.02.021
dc.identifier.uri
http://hdl.handle.net/11351/13990
dc.description.abstract
Fármacos antirreumáticos; Reproducción; Embarazo
dc.description.abstract
Antirheumatic drugs; Reproduction; Pregnancy
dc.description.abstract
Fàrmacs antireumàtics; Reproducció; Embaràs
dc.description.abstract
Objectives
This study aimed to summarise and update evidence to inform the 2024 update of the European Alliance of Associations for Rheumatology recommendations for the use of antirheumatic drugs in reproduction, pregnancy, and lactation.
Methods
A systematic literature review (SLR) was performed, including keywords on reproduction, adverse pregnancy outcomes (APOs), and lactation. Two appraised SLRs were the basis for the SLR on drug safety in men. If sufficient data were available, a meta-analysis was performed on maternal drug exposure and the risk of APOs.
Results
Of 6680 screened articles, 255 were included in the final analysis. In pregnancy, most evidence was available for biologic disease-modifying antirheumatic drugs (bDMARDs). Meta-analyses with adjusted risk estimates did not reveal APOs or serious infant infections to be associated with tumour necrosis factor inhibitor (TNFi) use. Data on non-TNFi bDMARDs did not raise concerns. In bDMARD-exposed infants, no serious adverse effects to rotavirus live vaccination were reported. Safety of Bacille Calmette–Guérin vaccination in TNFi-exposed infants could be a concern in the first 6 months of life. Regarding oral glucocorticoids, the SLR and meta-analysis using adjusted risk estimates found a dose-dependent association with an increased risk of preterm birth. Nonsteroidal anti-inflammatory drug use could reversibly reduce fecundability. Concerning lactation, available data on various bDMARDs was reassuring. In male patients, available evidence on methotrexate and most other drugs did not reveal adverse effects on sperm quality or birth outcomes. Cyclophosphamide remains the only drug that causes a dose-dependent irreversible infertility.
Conclusions
This SLR provides up-to-date evidence to guide the 2024 update of the European Alliance of Associations for Rheumatology recommendations for the use of antirheumatic drugs in reproduction, pregnancy, and lactation.
dc.description.abstract
This work was supported by the European League Against Rheumatism as project QoC012.
dc.format
application/pdf
dc.relation
Annals of the Rheumatic Diseases;84(9)
dc.relation
https://doi.org/10.1016/j.ard.2025.02.021
dc.rights
Attribution-NonCommercial-NoDerivatives 4.0 International
dc.rights
http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights
info:eu-repo/semantics/openAccess
dc.subject
Reumatisme - Tractament
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Antireumàtics - Ús terapèutic
dc.subject
DISEASES::Musculoskeletal Diseases::Rheumatic Diseases
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Other subheadings::Other subheadings::Other subheadings::/drug therapy
dc.subject
PHENOMENA AND PROCESSES::Reproductive and Urinary Physiological Phenomena::Reproductive Physiological Phenomena::Reproduction
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PHENOMENA AND PROCESSES::Reproductive and Urinary Physiological Phenomena::Reproductive Physiological Phenomena::Reproduction::Pregnancy
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PHENOMENA AND PROCESSES::Reproductive and Urinary Physiological Phenomena::Reproductive Physiological Phenomena::Lactation
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CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Antirheumatic Agents
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ENFERMEDADES::enfermedades musculoesqueléticas::enfermedades reumáticas
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Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia
dc.subject
FENÓMENOS Y PROCESOS::fenómenos fisiológicos reproductivos y urinarios::fenómenos fisiológicos de la reproducción::reproducción
dc.subject
FENÓMENOS Y PROCESOS::fenómenos fisiológicos reproductivos y urinarios::fenómenos fisiológicos de la reproducción::reproducción::embarazo
dc.subject
FENÓMENOS Y PROCESOS::fenómenos fisiológicos reproductivos y urinarios::fenómenos fisiológicos de la reproducción::lactancia
dc.subject
COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antirreumáticos
dc.title
Antirheumatic drugs in reproduction, pregnancy, and lactation: a systematic literature review informing the 2024 update of the EULAR recommendations
dc.type
info:eu-repo/semantics/article
dc.type
info:eu-repo/semantics/publishedVersion
