Background/Purpose:

Biologic drugs are effective therapeutic option in patients with juvenile idiopathic arthritis (JIA). However, data regarding the use during pregnancy and breastfeeding in adult women with JIA are rare. The purpose of this report is to summarize the pregnancy outcomes in adult female patients with JIA treated with TNF inhibitors (TNFi) and with other biologic agents.

Methods:

Pregnant patients with JIA have been prospectively followed since 2003 to 2015. The length of pregnancy, complications, preterm delivery, birth defects and disease exacerbations after delivery were entered into the database. Patients were treated with TNFi or with rituximab, abatacept and tocilizumab in recommended doses for rheumatoid arthritis. Data on disease activity, safety and doses of used medication were extracted from the Czech national registry of patients treated with biologics (ATTRA).

Results:

JIA patients were diagnosed with RF positive polyarthritis (9), RF negative polyarthritis (10), extended oligoarthritis (7), psoriatic arthritis (1) and arthritis with enthesitis (1). Twenty five live births in 28 pregnancies were observed. The age of mothers at the onset of pregnancy was 28,1 (range 20 -40) years. Nine patients discontinued biologicals shortly before the pregnancy was confirmed. In 19 cases patients were exposed to biological drugs after conception; infliximab in 4 cases, etanercept in 9, adalimumab in 3, certolizumab in 2 and abatacept in 1. Biologic drugs were administered for 6-8 weeks during pregnancy in 17 cases. One patient who discontinued etanercept was returned on the drug at week 26 because of severe JIA relapse and the drug was administered until the delivery. One patient received etanercept throughout of pregnancy in halved dose due to a persistent activity. Two pregnancies were not planned and both patients were exposed to methotrexate in the first 6 weeks in addition to exposure to rituximab 4 and 8 months before conception.  

One patient treated with infliximab had spontaneous abortion at week 7. Repeated pregnancy in this patient with the exposure to infliximab for 4 weeks was successful. Another spontaneous abortion was seen in patient exposed to adalimumab at week 6. There was one still birth terminated at week 11 in a patient on etanercept stopped at week 6 of gestation. All the other pregnancies were uneventful with just one case of hypertension. Gestation was terminated by Caesarean section in six cases (1x hypertension, 2x limited hip movement, 1x non-functional placenta, 1x JIA activity and 1x foetus defective position). There was no preterm delivery.

Birth weight was between 2470- 4000 grams. One child was born with mastocytosis.

Conclusion:

Our data from 28 pregnancies suggest that the use of biologics in the early phases of gravidity in JIA patients is safe and does not affect the gestation duration or the delivery or lead to increased frequency of birth defects.

Supported by the project (Ministry of Health, Czech Republic) for conceptual development of research organization 00023728 (Institute of Rheumatology)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancy-outcomes-in-adult-juvenile-idiopathic-arthritis-patients-treated-with-biologic-agents/