Perceptions of Pregnancy and Lactation from the Pregnancy and Lactation Autoimmune Network Registry

Objective.The Pregnancy and Lactation Autoimmune Network (PLAN) registry was established to evaluate the concerns of women with autoimmune or inflammatory rheumatic diseases (AIRD) pertaining to pregnancy and lactation.Methods.The registry was started as a survey of patients with AIRD at a single rheumatology specialty center in November 2016 and included questions regarding fertility, pregnancy, miscarriages, and lactation before and after diagnosis.Results.The study included 154 subjects from the PLAN registry. More than half (52%) of respondents indicated that their diagnosis negatively changed their views on pregnancy and nearly a third (30%) decided not to have children after AIRD diagnosis. Most (66%) women were concerned that medication use during the childbearing process would affect the baby. One-third (34%) indicated their views on breastfeeding negatively changed as a result of their disease diagnosis. The rates and duration of breastfeeding did not differ significantly for babies born before or after the mothers’ diagnosis (p = 0.50 and p = 0.21, respectively). Eighteen women in our study avoided breastfeeding or stopped breastfeeding earlier than planned to start a medication (including etanercept, adalimumab, hydroxychloroquine, and certolizumab) they believed to be contraindicated during lactation. The PLAN registry included 19 women who breastfed 22 babies while being exposed to a disease-modifying antirheumatic drug or biologic. None of these 19 women reported a delay in their children’s developmental milestones or higher infection rates.Conclusion.This study highlights an unmet need in patients with AIRD of childbearing potential for data and education regarding pregnancy and lactation.

Download Full-text

Introduction and switching of biologic agents are associated with antidepressant and anxiolytic medication use: data on 42 815 real-world patients with inflammatory rheumatic disease

RMD Open ◽

10.1136/rmdopen-2020-001303 ◽

2020 ◽

Vol 6 (3) ◽

pp. e001303

Author(s):

Vasiliki-Kalliopi Bournia ◽

Maria G Tektonidou ◽

Dimitrios Vassilopoulos ◽

Katerina Laskari ◽

Stylianos Panopoulos ◽

...

Keyword(s):

Mood Disorders ◽

Real World ◽

Medication Use ◽

Disease Diagnosis ◽

Biologic Agents ◽

Inflammatory Rheumatic Diseases ◽

Prescription Database ◽

Depression And Anxiety ◽

Patient Reported ◽

The Impact

ObjectivesDepression and anxiety are linked bi-directionally with inflammatory rheumatic diseases (IRDs) activity, which in turn, depends on subjective patient reported outcomes that can be distorted by comorbid mood disorders. We tested the hypothesis that introduction and/or switching of biologic agents for IRDs are associated with treatment for depression and/or anxiety, by analysing real-world data.MethodsUsing a country-wide electronic prescription database (10 012 604 registered, 99% population coverage), we captured almost all patients with rheumatoid arthritis (n=12 002), psoriatic arthritis (n=5465) and ankylosing spondylitis (n=6423) who received biologic disease modifying anti-rheumatic drugs (bDMARDs) during a 2-year period (8/2016–7/2018). Concomitant antidepressant/anxiolytic medication use was documented in patients who started or switched bDMARDs and compared with those who remained on conventional synthetic (cs)DMARDs or the same bDMARD, respectively, by multivariate regression analysis.ResultsTwo-year data analysis on 42 815 patients revealed that bDMARD introduction was associated with both antidepressant [OR: 1.248, 95% CI 1.153 to 1.350, p<0.0001] and anxiolytic medication use [OR: 1.178, 95% CI 1.099 to 1.263, p<0.0001]. Moreover, bDMARD switching was also associated with antidepressant [OR: 1.502, 95% CI 1.370 to 1.646, p<0.0001] and anxiolytic medication use [OR: 1.161, 95% CI 1.067 to 1.264, p=0.001]. Notably, all these associations were independent of age, gender, underlying disease diagnosis and concomitant glucocorticoid or csDMARD medication use.ConclusionIn real-world settings, both introduction and switching of bDMARDs in patients with IRDs were associated with the presence of mood disorders. Although a causal relationship is uncertain, the impact of depression and anxiety should always be considered by physicians facing the decision to introduce or switch bDMARDs in patients with active IRDs.

Download Full-text

Psychotropic and pain medication use in individuals with traumatic brain injury—a Swedish total population cohort study of 240 000 persons

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2020-324353 ◽

2021 ◽

Vol 92 (5) ◽

pp. 519-527

Author(s):

Yasmina Molero ◽

David James Sharp ◽

Brian Matthew D'Onofrio ◽

Henrik Larsson ◽

Seena Fazel

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Total Population ◽

Medication Use ◽

Population Based ◽

Pain Medication ◽

Short Term ◽

Pain Medications ◽

Before And After

ObjectiveTo examine psychotropic and pain medication use in a population-based cohort of individuals with traumatic brain injury (TBI), and compare them with controls from similar backgrounds.MethodsWe assessed Swedish nationwide registers to include all individuals diagnosed with incident TBI between 2006 and 2012 in hospitals or specialist outpatient care. Full siblings never diagnosed with TBI acted as controls. We examined dispensed prescriptions for psychotropic and pain medications for the 12 months before and after the TBI.ResultsWe identified 239 425 individuals with incident TBI, and 199 658 unaffected sibling controls. In the TBI cohort, 36.6% had collected at least one prescription for a psychotropic or pain medication in the 12 months before the TBI. In the 12 months after, medication use increased to 45.0%, an absolute rate increase of 8.4% (p<0.001). The largest post-TBI increases were found for opioids (from 16.3% to 21.6%, p<0.001), and non-opioid pain medications (from 20.3% to 26.6%, p<0.001). The majority of prescriptions were short-term; 20.6% of those prescribed opioids and 37.3% of those with benzodiazepines collected prescriptions for more than 6 months. Increased odds of any psychotropic or pain medication were associated with individuals before (OR: 1.62, 95% CI: 1.59 to 1.65), and after the TBI (OR: 2.30, 95% CI: 2.26 to 2.34) as compared with sibling controls, and ORs were consistently increased for all medication classes.ConclusionHigh rates of psychotropic and pain medications after a TBI suggest that medical follow-up should be routine and review medication use.

Download Full-text

Changes in Body Composition Before and After Parkinson's Disease Diagnosis

Movement Disorders ◽

10.1002/mds.28536 ◽

2021 ◽

Author(s):

Shengfang Song ◽

Zhehui Luo ◽

Chenxi Li ◽

Xuemei Huang ◽

Eric J. Shiroma ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Body Composition ◽

Disease Diagnosis ◽

Before And After

Download Full-text

Medication use in the treatment of migraine during pregnancy and lactation

Current Pain and Headache Reports ◽

10.1007/s11916-009-0064-3 ◽

2009 ◽

Vol 13 (5) ◽

pp. 392-398 ◽

Cited By ~ 25

Author(s):

Sylvia Lucas

Keyword(s):

Medication Use ◽

Pregnancy And Lactation

Download Full-text

Medication use in pregnancy and lactation: A gap to be filled in postgraduate medical education

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2021.03.010 ◽

2021 ◽

Vol 260 ◽

pp. 52-55

Author(s):

Claire M. McCarthy ◽

Fergal O’Shaughnessy ◽

Nicola Maher ◽

Brian J. Cleary ◽

Jennifer C. Donnelly

Keyword(s):

Medical Education ◽

Postgraduate Medical Education ◽

Medication Use ◽

Pregnancy And Lactation ◽

In Pregnancy

Download Full-text

Blood Cholesterol Decreases as Parkinson’s Disease Develops and Progresses

Journal of Parkinson s Disease ◽

10.3233/jpd-212670 ◽

2021 ◽

pp. 1-10

Author(s):

Keran Wang ◽

Zhehui Luo ◽

Chenxi Li ◽

Xuemei Huang ◽

Eric J. Shiroma ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Confidence Interval ◽

Total Cholesterol ◽

Cholesterol Level ◽

Disease Diagnosis ◽

Inverse Association ◽

Prodromal Stage ◽

Before And After ◽

Blood Total Cholesterol

Background: Literature shows an inverse association of circulating cholesterol level with the risk of Parkinson’s disease (PD); this finding has important ramifications, but its interpretation has been debated. Objective: To longitudinally examine how blood total cholesterol changes during the development of PD. Methods: In the Health, Aging and Body Composition study (n = 3,075, 73.6±2.9 years), blood total cholesterol was measured at clinic visit years 1, 2, 4, 6, 8, 10, and 11. We first examined baseline cholesterol in relation to PD risk, adjusting for potential confounders and competing risk of death. Then, by contrasting the observed with expected cholesterol levels, we examined the trajectory of changes in total cholesterol before and after disease diagnosis. Results: Compared to the lowest tertile of baseline total cholesterol, the cumulative incident ratio of PD and 95%confidence interval was 0.41 (0.20, 0.86) for the second tertile, and 0.69 (0.35, 1.35) for the third tertile. In the analysis that examined change of total cholesterol level before and after PD diagnosis, we found that its level began to decrease in the prodromal stage of PD and became statistically lower than the expected values∼4 years before disease diagnosis (observed-expected difference, –6.68 mg/dL (95%confidence interval: –13.14, –0.22)). The decreasing trend persisted thereafter; by year-6 post-diagnosis, the difference increased to –13.59 mg/dL (95%confidence interval: –22.12, –5.06), although the linear trend did not reach statistical significance (p = 0.10). Conclusion: Circulating total cholesterol began to decrease in the prodromal stage of PD, which may in part explain its reported inverse association with PD.

Download Full-text

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

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4279 ◽

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

Download Full-text

Sex Differences in Medication and Primary Healthcare Use before and after Spousal Bereavement at Older Ages in Denmark: Nationwide Register Study of over 6000 Bereavements

Journal of Aging Research ◽

10.4061/2011/678289 ◽

2011 ◽

Vol 2011 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

Anna Oksuzyan ◽

Rune Jacobsen ◽

Karen Glaser ◽

Cecilia Tomassini ◽

James W. Vaupel ◽

...

Keyword(s):

Sex Differences ◽

Health Outcomes ◽

Medication Use ◽

Annual Number ◽

Healthcare Use ◽

Adverse Health ◽

Adverse Health Outcomes ◽

Before And After ◽

Conjugal Loss ◽

Gp Visits

Background. The study aimed to examine sex differences in healthcare use before and after widowhood to investigate whether reduced healthcare use among widowers compared with widows may partially explain excess mortality and more adverse health outcomes among men than women after spousal loss.Methods. All individuals alive and aged at least 60 years in 1996 and who became widowed in the period from 1996 to 2003 were selected from the 5% sample of the total Danish population and all Danish twins. The healthcare use was assessed as the average daily all-cause and major system-specific medication use and the average annual number of visits to general physicians (GPs).Results. The average daily use of all-cause and major system-specific medications, as well as the number of GP visits increased over the period from 1 year before and up to 5 years after a spouse's death, but there were no sex-specific patterns in the trajectories of medication use and number of GP visits after conjugal loss.Conclusion. We found little support for the hypothesis that reduced healthcare use contributes to the explanation of more adverse health outcomes after conjugal loss in men compared with women in Denmark.

Download Full-text