scholarly journals The Safety of Medications During Pregnancy and Lactation in Patients with Inflammatory Rheumatic Diseases

2021 ◽  
Author(s):  
Ji-Won Kim ◽  
Chang-Hee Suh
Keyword(s):  
Rheumatic Diseases ◽  
Low Dose ◽  
Post Partum ◽  
Severe Disease ◽  
Inflammatory Rheumatic Diseases ◽  
Low Dose Aspirin ◽  
Pregnancy And Lactation ◽  
Inflammatory Drugs ◽  
Adverse Pregnancy ◽  
The Individual

The advances in treatments, including disease-modifying anti-rheumatic drugs and biologic agents, have significantly improved the management of inflammatory rheumatic diseases, allowing females with severe disease to become pregnant and lactate, previously considered as prohibited. Maintaining low disease activity with medications known to be safe from pre-conception to post-partum is a key point in reducing adverse pregnancy outcomes. Numerous observational and case studies have provided a growing amount of evidence on the use of safe anti-rheumatic medications in patients during pregnancy and lactation. Based on this information, this review discusses the safety of medications for patients with inflammatory rheumatic diseases during pregnancy and lactation. Among these, hydroxychloroquine, sulfasalazine, azathioprine, low-dose glucocorticoids, and low-dose aspirin are considered compatible with pregnancy, while methotrexate, cyclophosphamide, mycophenolate mofetil, and leflunomide are contraindicated. Non-steroidal anti-inflammatory drugs are only recommended for use early in pregnancy, as they are reported to cause rare but serious kidney problems in the fetus after 20 weeks or later. Cyclosporin, tacrolimus, and anti-TNF agents can be continued throughout pregnancy if the benefit is greater than the potential risk for the individual patient. Physicians should carefully weigh the risks and benefits of medications in patients with inflammatory rheumatic diseases considering pregnancy.

scholarly journals STW1 and Its Versatile Pharmacological and Clinical Effects in Rheumatic Disorders: A Comprehensive Report

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Karl-Josef Gundermann ◽  
Jürgen Müller ◽  
Karin Kraft
Keyword(s):  
Rheumatic Diseases ◽  
Safety Profile ◽  
Comparable Efficacy ◽  
Inflammatory Rheumatic Diseases ◽  
Clinical Effects ◽  
Double Blind ◽  
Solidago Virgaurea ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
The Individual

Aim. To review the published and unpublished experimental and clinical studies about the efficacy and tolerability of STW1 and to compare the results to the efficacy and tolerability of investigated NSAIDs in parallel. Content. STW1 (Phytodolor®) contains a fixed combination of extracts from aspen leaves and bark (Populus tremula), common ash bark (Fraxinus excelsior), and goldenrod herb (Solidago virgaurea). It belongs to the group of anti-inflammatory and antirheumatic drugs, and it is authorized for the treatment of painful disorders of degenerative and inflammatory rheumatic diseases. The individual components have complementary effects. Its multifocal mode of action includes antiphlogistic, analgesic, antiexudative, antioxidative, antipyretic, and antiproliferative properties. The effects of both STW1 and its components have been verified in comprehensive pharmacological investigations. Open and randomized, placebo- and verum-controlled, and single-blind (sb) or double-blind (db) clinical trials, performed in different subtypes of rheumatic diseases confirm the pharmacological evidence. Its efficacy is comparable to a range of standard nonsteroidal anti-inflammatory drugs (NSAIDs) studied in parallel, but it has a superior safety profile. Conclusion. STW1 is a reasonable alternative to NSAIDs with comparable efficacy and a superior safety profile. It is also suitable to reduce the intake of NSAIDs.

FRI0279 USE OF TNF-INHIBITORS BEFORE, DURING AND THE FIRST YEAR AFTER PREGNANCY IN WOMEN WITH SPONDYLOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 727.1-727
Author(s):  
H. Bjørngaard ◽  
H. Koksvik ◽  
B. Jakobsen ◽  
M. Wallenius
Keyword(s):  
Disease Activity ◽  
Post Partum ◽  
Tnf Inhibitors ◽  
Treat To Target ◽  
Inflammatory Rheumatic Diseases ◽  
Tnf Inhibitor ◽  
Quality Register ◽  
Frequency Of Use ◽  
Asas Criteria ◽  
Pregnancy And Lactation

Background:Treat to target is a goal in pregnant women with spondyloarthristis. There is increasing evidence on safe use with TNF inhibitors during pregnancy (1). Adjusted use of TNF inhibitors preconception and throughout pregnancy may stabilize disease activity and prevent flares (2). Low disease activity is also beneficial for the fetus.Objectives:To study the use of TNF-inhibitors among women with spondyloarthritis in Norway before, during and after pregnancy.Methods:RevNatus is a Norwegian, nationwide quality register that monitors treatment of inflammatory rheumatic diseases before, during and after pregnancy. Data from RevNatus in the period October 2017 to October 2019 were used to map the use of all types of TNF inhibitors among 208 women with spondyloarthitis, fulfilling the ASAS criteria.The use of medication was reported at the time of visit in outpatient clinic. The frequency of use of TNF inhibitors is registered at seven timepoints from pre-pregnancy to twelve months after delivery.Results:The use of TNF-inhibitors was reported at each visit for all the women with spondyloarthritis. Most women are not using TNF inhibitors before and beyond conception. Most of the women continuing TNF inhibitors beyond conception, used certolizumab, etanercept, or adalimumab. Infliximab or golimumab were not used in pregnancy (tabell 2).Table 2:SPACertoli-zumabEtaner-ceptAdali-mumabGolim-umabInflik-simabNo TNF -inhibitorBefore Pregnancyn=13910% (14)8% (11)6% (9)6% (9)69% (96)1.trimestern=1027% (7)7% (7)2 % (2)84% (86)2.trimestern=1047% (7)6% (6)1% (1)87% (90)3. trimestern=953% (3)2% (2)1% (1)94% (89)6 weeks post partumn=10015% (15)10% (10)8% (8)3% (3)64% (64)6 months post partumn=8219% (16)12% (10)7% (6)2% (2)2% (2)55% (46)12 months post partumn=7422% (16)15% (11)7% (5)4% (3)5% (4)47% (35)Conclusion:A majority of the women with spondyloarthritis were not treated with TNF inhibitors before or during pregnancy. Only a few of the women with spondylosthritis continued treatment with TNF inhibitors during pregnancy.References:[1]Gotestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. 2016;75(5):795-810.[2]van den Brandt S, Zbinden A, Baeten D, Villiger PM, Ostensen M, Forger F. Risk factors for flare and treatment of disease flares during pregnancy in rheumatoid arthritis and axial spondyloarthritis patients. Arthritis Res Ther. 2017;19(1):64.Disclosure of Interests:None declared

scholarly journals Dose-dependent roles of aspirin and other non-steroidal anti-inflammatory drugs in abnormal bone remodeling and skeletal regeneration

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yong Xie ◽  
Meng Pan ◽  
Yanpan Gao ◽  
Licheng Zhang ◽  
Wei Ge ◽  
...  
Keyword(s):  
Bone Formation ◽  
Bone Remodeling ◽  
Low Dose ◽  
High Dose ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Dose Dependent ◽  
High Dose Aspirin

AbstractThe failure of remodeling process that constantly regenerates effete, aged bone is highly associated with bone nonunion and degenerative bone diseases. Numerous studies have demonstrated that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) activate cytokines and mediators on osteoclasts, osteoblasts and their constituent progenitor cells located around the remodeling area. These cells contribute to a complex metabolic scenario, resulting in degradative or synthetic functions for bone mineral tissues. The spatiotemporal effects of aspirin and NSAIDs in the bone remodeling are controversial according the specific therapeutic doses used for different clinical conditions. Herein, we review in vitro, in vivo, and clinical studies on the dose-dependent roles of aspirin and NSAIDs in bone remodeling. Our results show that low-dose aspirin (< 100 μg/mL), which is widely recommended for prevention of thrombosis, is very likely to be benefit for maintaining bone mass and qualities by activation of osteoblastic bone formation and inhibition of osteoclast activities via cyclooxygenase-independent manner. While, the roles of high-dose aspirin (150–300 μg/mL) and other NSAIDs in bone self-regeneration and fracture-healing process are difficult to elucidate owing to their dual effects on osteoclast activity and bone formation of osteoblast. In conclusion, this study highlighted the potential clinical applications of low-dose aspirin in abnormal bone remodeling as well as the risks of high-dose aspirin and other NSAIDs for relieving pain and anti-inflammation in fractures and orthopedic operations.

scholarly journals Anticardiolipin Positivity Is Highly Associated With Intrauterine Growth Restriction in Women With Antiphospholipid Syndrome

2020 ◽  
Vol 26 ◽  
pp. 107602962097445
Author(s):  
Fangfang Xi ◽  
Yuliang Cai ◽  
Min Lv ◽  
Ying Jiang ◽  
Feifei Zhou ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Intrauterine Growth Restriction ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Low Molecular Weight ◽  
Intrauterine Growth ◽  
Factors Associated ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Adverse Pregnancy

The purpose of our study was to evaluate pregnancy outcomes of women with antiphospholipid antibodies (aPL) positivity and assess risk factors associated with adverse pregnancy outcomes. Pregnant women with aPL positivity were enrolled prospectively in China from January 2017 to March 2020. Treatment of low-dose aspirin and low molecular weight heparin were given. Pregnancy outcomes and coagulation function were recorded and compared with normal pregnancies. Multivariable logistic regression was performed to identify risk factors associated to intrauterine growth restriction (IUGR). 270 pregnant women, including 44 diagnosed as Antiphospholipid syndrome (APS), 91 as non-criteria APS (NCAPS) and 135 normal cases as control, were enrolled in the study. The live birth rate in aPL carriers and APS group was 97% and 95.5%, respectively. Adverse pregnancy outcomes did not show significant difference between aPL carriers and normal pregnancies, and between APS and NCAPS, except for IUGR. The incidence of IUGR was significantly higher in aPL carriers than normal pregnancies, and in APS patients than NCAPS (P < 0.05). After controlling for age, in vitro fertilization (IVF), pregnancy losses related to APS and treatment, anticardiolipin (aCL) positivity was the only variable significantly associated with IUGR, with an adjusted odds ratio of 4.601 (95% CI, 1.205-17.573). Better pregnant outcomes of aPL positive women, include APS and NCAPS, were achieved in our study with treatment based on low-dose aspirin (LDA) plus low molecular weight heparin (LMWH). The incidence of IUGR was still higher in them, and aCL positivity was the only one risk factor associated with IUGR.

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