AUTHOR=Tahmasian Helena , Smeele Hieronymus T. W. , de Jong Pascal H.P. , Dolhain Radboud J. E. M. , van Mulligen Elise 

TITLE=Biological and Methotrexate Survival after Pregnancy in Patients With a Rheumatic Disease

JOURNAL=Frontiers in Pharmacology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.826034

DOI=10.3389/fphar.2022.826034

ISSN=1663-9812

ABSTRACT=Objective: Patients with a rheumatic disease who discontinue their disease-modifying anti-rheumatic drug (DMARD) due to pregnancy often wonder if treatment will be as effective after pregnancy. This study investigates the effect of a temporary discontinuation of DMARDs due to pregnancy on the effectiveness of the same DMARD postpartum in patients with a rheumatic disease. 
Methods: Pregnant, rheumatic patients were derived from the Preconceptional Counseling in Active Rheumatoid Arthritis (PreCARA) cohort. DMARD-survival after pregnancy, for biological and methotrexate (MTX) therapy, was analyzed and compared to controls with stable DMARD-treatment from a retrospective cohort.
Results: In total, 234 patients were included, of whom 114 patients had stable biological or MTX treatment before their pregnancy. After pregnancy, 40 out of 56 (71%) patients restarted their biological, for MTX this was 49%. One year after restart, and censoring for a following pregnancy, 88.9% of patients were still using their biological, and 85% still used their MTX (p=0.92). Compared to the matched controls the survival after pregnancy was significantly lower one year after restart for both biologicals (98.3%) and MTX (99.6%); p=0.002 and p<0.001 respectively; three years after restart this significant difference was no longer observed (p=0.50 and p=0.33, respectively). 
Conclusion: Effective DMARD (biological or MTX) treatment before pregnancy that was discontinued due to pregnancy seems effective after pregnancy. Although DMARD-survival was higher in the control group one year after restart, the percentage of patients with effective treatment was still very good (>85%). In addition, this difference was no longer observed after three years.