Session Information
Date: Tuesday, November 10, 2015
Title: Reproductive Issues in Rheumatic Disorders: Basic and Clinical Aspects Poster Session
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: To examine difference in the
prevalence of immunosuppressive medication use during pregnancy by type of
autoimmune disease and by insurance (Medicaid versus commercial) in an analysis
of administrative claims databases.
Methods: We identified women who were diagnosed with
rheumatoid arthritis, psoriatic arthritis, psoriasis, and inflammatory bowel
disease (ulcerative colitis and Crohn’s disease) and had a live birth between
2006-2010 (Medicaid) and 2005-2012 (commercial). Eligible women were identified
by requiring ≥ 2 physician diagnoses for the diseases or one diagnosis
plus ≥ 1 filled prescription(s) for an immunosuppressive medication at
any time prior to and during pregnancy. In addition, they were required to have
both medical and pharmacy coverage continuously during the 12 months period
prior to delivery. We determined the use of immunosuppressive medications by
examining filled prescriptions and calculated the prevalence of each medication
during 4 separate time periods: preconception (90 days prior through
conception), 1st trimester (day 270-180 prior to delivery), 2nd
trimester (day 180-90 prior to delivery), and the 3rd trimester (day
90 prior through delivery). In addition, among biologic users during
preconception with Medicaid coverage, we examined the proportion of patients
who had discontinued by the 3rd trimester.
Results: We identified 5,909 pregnant women with
autoimmune diseases enrolled in Medicaid and 1,104 commercially insured. Women
with Medicaid coverage were younger compared to those commercially insured at
time of delivery (mean age 27 versus 31 years). Biologics were the most
commonly used DMARDs across all diseases and throughout the 4 time periods
(Table). We observed a decline in the prevalence of biologics use from
preconception to 3rd trimester in both Medicaid and commercially
insured populations and across all diseases (Table). Among RA patients, 12-14%
had a filled prescription during preconception compared to 3% in the 3rd
trimester. Despite a lower prevalence (7-8%) of biologics use during
preconception among women with inflammatory bowel disease, the prevalence
(3-5%) in the 3rd trimester was similar to that among RA patients.
Among biologic users during preconception enrolled in Medicaid, 83% of RA
patients had discontinued by the 3rd trimester compared to 65% of
IBD patients.
Conclusion: Irrespective of type of insurance,
biologics were the most commonly used DMARDs during and immediately prior to
pregnancy among women with inflammatory autoimmune diseases. Prevalence rates
of biologics use differed by diagnoses but were not different between Medicaid
and commercially insured. Further research to evaluate potential
under-treatment of these diseases during pregnancy is warranted.
|
|
Rheumatoid Arthritis |
Psoriatic Arthritis |
Psoriasis |
Inflammatory Bowel Disease |
||||
|
|
Medicaid (Med) |
Commercial (Com) |
Med |
Com |
Med |
Com |
Med |
Com |
|
N |
2177 |
299 |
137 |
31 |
1917 |
187 |
1612 |
400 |
|
Preconception |
||||||||
|
Any Biologic, % |
12.4 |
14.0 |
27.7 |
8.6 |
3.8 |
2.4 |
7.0 |
7.5 |
|
Hydroxychloroquine, % |
11.2 |
12.2 |
2.2 |
|
0.2 |
0.3 |
0.1 |
|
|
Sulfasalazine, % |
1.7 |
2.1 |
|
|
|
|
2.1 |
2.1 |
|
Azathioprine, % |
0.6 |
0.6 |
0.7 |
|
0.1 |
|
2.5 |
0.5 |
|
Mercaptopurine, % |
0.2 |
|
|
|
0.1 |
1.4 |
3.9 |
4.7 |
|
Methotrexate, % |
8.6 |
3.9 |
8.0 |
2.9 |
0.5 |
0.3 |
0.3 |
|
|
1st Trimester |
||||||||
|
Any Biologic, % |
8.9 |
10.4 |
20.4 |
8.6 |
2.4 |
1.4 |
5.3 |
5.8 |
|
Hydroxychloroquine, % |
8.7 |
6.8 |
2.2 |
|
0.2 |
0.3 |
|
|
|
Sulfasalazine, % |
1.0 |
1.5 |
|
2.9 |
0.1 |
|
1.6 |
2.1 |
|
Azathioprine, % |
1.4 |
0.6 |
0.7 |
|
0.1 |
|
1.7 |
0.2 |
|
Mercaptopurine, % |
0.1 |
|
|
|
|
0.7 |
2.7 |
4.0 |
|
Methotrexate, % |
4.3 |
0.6 |
3.7 |
|
0.1 |
|
0.1 |
|
|
2st Trimester |
||||||||
|
Any Biologic, % |
3.6 |
3.3 |
10.2 |
5.7 |
1.3 |
1.0 |
4.2 |
5.1 |
|
Hydroxychloroquine, % |
5.1 |
1.5 |
0.7 |
|
0.1 |
|
|
|
|
Sulfasalazine, % |
0.6 |
0.6 |
|
|
|
|
1.7 |
1.4 |
|
Azathioprine, % |
0.3 |
|
|
|
0.1 |
|
0.8 |
0.5 |
|
Mercaptopurine, % |
|
|
|
|
|
0.7 |
1.6 |
3.3 |
|
Methotrexate, % |
0.8 |
|
|
|
|
|
|
|
|
3st Trimester |
||||||||
|
Any Biologic, % |
2.5 |
3.3 |
6.6 |
5.7 |
0.6 |
1.0 |
3.2 |
4.9 |
|
Hydroxychloroquine, % |
4.0 |
2.1 |
0.7 |
|
0.2 |
|
|
|
|
Sulfasalazine, % |
0.5 |
0.6 |
|
|
|
|
0.7 |
2.3 |
|
Azathioprine, % |
0.3 |
|
|
|
0.1 |
|
0.6 |
0.5 |
|
Mercaptopurine, % |
0.1 |
|
|
|
|
0.7 |
0.9 |
3.7 |
|
Methotrexate, % |
0.3 |
|
|
|
0.1 |
|
|
|
|
% of biologic users during preconception who had discontinued by 3rd trimester |
||||||||
|
|
83% |
|
93% |
|
89% |
|
65% |
|
To cite this abstract in AMA style:
Zhang J, Curtis JR, Xie F, Mannion ML, Lewis JD, Clowse MEB, Saag KG, Bethard S, Biggio J, McGwin G, Beukelman T. Utilization of Immune-Suppressive Medications during Pregnancy Among Women with Inflammatory Arthritis and Other Autoimmune Diseases [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/utilization-of-immune-suppressive-medications-during-pregnancy-among-women-with-inflammatory-arthritis-and-other-autoimmune-diseases/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/utilization-of-immune-suppressive-medications-during-pregnancy-among-women-with-inflammatory-arthritis-and-other-autoimmune-diseases/