Pregnancy Outcomes of Targeted Synthetic Disease-Modifying Antirheumatic Drugs Among Patients with Autoimmune Diseases: A Scoping Review.

Abstract

Objectives: Targeted synthetic (ts)disease-modifying antirheumatic drugs (DMARDs) have expanded the management of autoimmune diseases, including rheumatic diseases. As use of these drugs grows, it is important to understand their effects on pregnancy. We conducted a scoping review to synthesize current evidence on the impacts of tsDMARDs on pregnancy outcomes.

Methods: We searched Embase, MEDLINE and CENTRAL databases in November 2023. We included studies that examined tsDMARD exposure for chronic autoimmune disease(s), particularly in mothers during pregnancy, fathers prior to conception and/or fetuses/neonates in-utero. We extracted data on sample size, study design, tsDMARD exposure (dose, duration), and reproductive health outcomes.

Results: Of 6,712 studies screened, 8 were included, namely 2 case reports, 1 case series, 4 cross-sectional studies, and 1 cohort study among patients with ulcerative colitis, rheumatoid arthritis and psoriasis. Sample sizes ranged 1 to 116 pregnancies or offspring, with 6 studies on tofacitinib, 1 on baricitinib, 1 on upadacitinib and no studies on apremilast. Overall, 19 fetal/neonatal outcomes, 6 fetal/neonatal-maternal outcomes, and 3 maternal outcomes were extracted. The most frequently reported fetal/neonatal outcomes were congenital anomaly (n=4) and preterm birth (n=4), and the fetal/neonatal-maternal outcome of spontaneous abortion (n=4). Only one study reported on the maternal outcome of delivery via Caesarean section.

Conclusion: Our scoping review of evidence to date on the perinatal use of tsDMARDs reveal small sample sizes and limited number of studies, all largely descriptive in nature. Findings highlight evidence gaps that preclude providers and patients from making informed decisions when considering perinatal use of tsDMARDs.