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"Faces" of the day:

Katharina Jandl

Nina Höller

Nariae Baik-Schneditz

Ellen Heitzer

Marianne Brodmann

Ewald Kolesnik

Bernhard Schwaberger

Maximilian Seles

Gabor Toth-Gayor

Lukas Peter Mileder

Niels Hammer

Christian Josef Hill

Christian Viertler

Philipp Klaritsch

Daniel Scherr

Harald Köfeler

Gerhard Pichler

Roland Malli

Michael Fuchsjäger

Gernot Plank

Peter Fickert

Richard Zigeuner

Peter Holzer

Selected Publication:

SHR Neuro Cancer Cardio Lipid Metab Microb

Rüegg, L; Pluma, A; Hamroun, S; Cecchi, I; Perez-Garcia, LF; Anderson, PO; Andreoli, L; Wirström, SB; Boyadhzieva, V; Chambers, C; Costedoat-Chalumeau, N; Dolhain, RJEM; Fischer-Betz, R; Giles, I; Gøtestam-Skorpen, C; Hoeltzenbein, M; Marchiori, F; Mayer-Pickel, K; Molto, A; Nelson-Piercy, C; Nielsen, OH; Tincani, A; Wallenius, M; Zbinden, A; Meissner, Y; Finckh, A; Förger, F.
EULAR recommendations for use of antirheumatic drugs in reproduction, pregnancy, and lactation: 2024 update.
Ann Rheum Dis. 2025; Doi: 10.1016/j.ard.2025.02.023
PubMed FullText FullText_MUG

 

Co-authors Med Uni Graz

Mayer-Pickel Karoline Ilse

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Abstract:

OBJECTIVES: To update the existing European Alliance of Associations for Rheumatology (EULAR) points to consider (PtC) for use of antirheumatic drugs in reproduction, pregnancy, and lactation, including additional drugs and adverse outcomes as well as paternal drug safety. METHODS: According to the EULAR standardised operating procedures, an international task force (TF) defined the questions for a systematic literature review, followed by formulation of the updated statements. A predefined voting process was applied to each overarching principle and statement. Level of evidence and strength of recommendation were assigned, and participants finally provided their level of agreement for each item. RESULTS: The TF proposes 5 overarching principles and 12 recommendations for the use of antirheumatic drugs before and during pregnancy, through lactation, and in male patients. The current evidence indicates that synthetic disease-modifying antirheumatic drugs (DMARDs) compatible with pregnancy include antimalarials, azathioprine, colchicine, cyclosporine, sulfasalazine, and tacrolimus. Regarding nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids, a more restrictive approach to their use during pregnancy is recommended. Based on an individualised risk-benefit assessment, all tumour necrosis factor inhibitor (TNFi) biologic DMARDs (bDMARDs) can be used throughout pregnancy, and non-TNFi bDMARDs may be used if needed. In relation to lactation, compatible drugs include antimalarials, azathioprine, colchicine, cyclosporine, glucocorticoids, intravenous immunoglobulin (IVIG), NSAIDs, sulfasalazine, and tacrolimus. All bDMARDs are considered compatible with breastfeeding. Concerning the use of drugs in men, compatible options include antimalarials, azathioprine, colchicine, cyclosporine, IVIG, leflunomide, methotrexate, mycophenolate, NSAIDs, glucocorticoids, sildenafil, sulfasalazine, tacrolimus, and bDMARDs. CONCLUSIONS: The updated recommendations provide consensus guidance and will help to improve the quality of care of patients during the phases of reproduction, pregnancy, and lactation.

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