(Press-News.org) ATLANTA — According to new research at ACR Convergence 2023, the American College of Rheumatology’s (ACR) annual meeting, continuing tumor necrosis factor inhibitors during pregnancy is not associated with worse fetal or obstetric outcomes and may reduce the risk of severe maternal infections during pregnancy (Abstract #0477).
Tumor necrosis factor (TNF) inhibitors such as adalimumab and infliximab are often prescribed for inflammatory forms of arthritis that have not improved with other treatments. Although studies suggest the drugs are safe during pregnancy, many women stop taking them out of fear of harming the fetus. Unlike other medications used for inflammatory arthritis such as methotrexate, which can cause severe fetal complications, TNF inhibitors are not known teratogens (any agent that causes abnormality following fetal exposure during pregnancy).
To further test the safety of continuing TNF inhibitors during pregnancy, Anna Molto, MD, PhD, HDR, a rheumatologist and researcher in at Cochin Hospital in Paris, France, and her colleagues used data from a nationwide French health insurance database to emulate a randomized clinical trial (RCT). This type of trial relies on observational data to conduct a study when a gold standard RCT may not be ethical or feasible.
The researchers identified more than 2,000 women treated with TNF inhibitors for rheumatoid arthritis (579 patients) or spondyloarthritis (1,503 patients) between 2008 and 2017. Each had a singleton pregnancy, with 1,497 (72%) discontinuing treatment on learning they were pregnant. The mean age of the women at the start of pregnancy was 31± 5 years and mean disease duration was 4 ± 5 years.
The results showed no statistically significant difference in poor obstetric, fetal, or infant outcomes, including spontaneous abortion (a loss of pregnancy naturally before twenty weeks of gestation), medical termination of pregnancy, pre-eclampsia or eclampsia, gestational diabetes, preterm birth, small birth weight or major birth defects.
Interestingly, women who continued TNF inhibitors were less likely to be hospitalized for severe infections during pregnancy for six weeks postpartum compared to those who stopped treatment (0.2 vs. 1.3 percent, respectively). Molto says this finding was the most surprising.
“Although we had hypothesized that pregnancy outcomes would at least be comparable in both groups, we did not expect to have a lower risk of maternal infections in patients continuing TNFi, as infection risk is known to be increased with these treatments,” she says. She speculates the finding may be due to lower concomitant use of corticosteroids but does not yet have the results to confirm her theory.
Regarding the overall study results, Molto says, “This data contributes to the increasing reassuring data on the use of TNFi during pregnancy. And more important, if a rheumatologist thinks about stopping a TNFi during pregnancy because of infection risk, this study suggests that this might not be justified.”
Molto acknowledges the limitations of relying on claims data, noting that disease activity can’t be measured, but also points out that using a nationwide database insures that “all French participants are included, [thereby avoiding] selection bias.”
The next step, Molto says, is to test the hypothesis in a randomized controlled trial.
This research was conducted thanks to the French Ministry of Health Funding Program.
###
About ACR Convergence
ACR Convergence, the annual meeting of the American College of Rheumatology, is where rheumatology meets to collaborate, celebrate, congregate, and learn. With more than 240 sessions and thousands of abstracts, it offers a superior combination of basic science, clinical science, business education and interactive discussions to improve patient care. For more information about the meeting, visit https://rheumatology.org/annual-meeting, or join the conversation on Twitter by following the official hashtag (#ACR23).
About the American College of Rheumatology
Founded in 1934, the American College of Rheumatology (ACR) is a not-for-profit, professional association committed to advancing the specialty of rheumatology that serves nearly 8,500 physicians, health professionals, and scientists worldwide. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatology professionals are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit www.rheumatology.org.
END
ATLANTA - New research at ACR Convergence 2023, the American College of Rheumatology’s (ACR) annual meeting, reports the incidence and risk factors for new-onset interstitial lung disease (ILD) in previously ILD-negative systemic sclerosis patients (Abstract #1700).
Interstitial lung disease is a common complication and cause of death in systemic sclerosis (SSc, scleroderma). Although the prevalence and risk factors for ILD are well known, less is known about the annual incidence and risk factors associated with the disease that occurs in patients who test negative on screening tests conducted at baseline. To answer these questions, Liubov Petelytska, ...
In a small study, researchers at the National Institutes of Health have found that positron emission tomography (PET) scans of the heart may identify people who will go on to develop Parkinson’s disease or Lewy body dementia among those at-risk for these diseases. The findings, published in the Journal of Clinical Investigation and led by scientists at the National Institute of Neurological Disorders and Stroke (NINDS), part of NIH, may advance efforts to detect the earliest changes that years later lead to Parkinson’s disease and Lewy body dementia.
In ...
Macarena de la Fuente, MD, chief of neuro-oncology at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, has been elected to the Society of Neuro-Oncology (SNO)’s board of directors.
She will serve as the neurology representative and becomes the first Hispanic elected to the multidisciplinary board, which strives to advance brain tumor research, education and collaboration.
De la Fuente has been an SNO member for over a decade and previously served as chair of the society’s ...
ATLANTA — New research at ACR Convergence 2023, the American College of Rheumatology’s annual meeting, demonstrates that CAR-T cell therapy could lead to sustained suppression of autoantibodies in treatment-resistant lupus while maintaining a robust response to vaccines (Abstract #0607).
Systemic lupus erythematosus (SLE, lupus) is a complex autoimmune disease marked by the production of autoantibodies to nucleic acid DNA and nuclear protein autoantigens and is associated with dysfunctional B cells. It mainly affects women and is more common and severe in people who ...
PLYMOUTH MEETING, PA [November 7, 2023] — New research in the November 2023 issue of JNCCN—Journal of the National Comprehensive Cancer Network suggests that patients who have insufficient levels of vitamin D before starting paclitaxel treatment are more likely to experience peripheral neuropathy. According to an analysis of 1,191 patients with early-stage breast cancer—using data collected in the SWOG S0221 study—20.7% of patients with vitamin D deficiency experienced at least a grade 3 level of chemotherapy-induced peripheral neuropathy (CIPN), compared to 14.2% of those with sufficient vitamin D levels. The researchers ...
The rapid adoption of zero-emission electric vehicles will move the nation close to an 80% or more drop in transportation greenhouse gas emissions by 2050 from the 2019 level according to researchers from the U.S. Department of Energy’s National Renewable Energy Laboratory (NREL).
The researchers came to that conclusion after running thousands of computer simulations on the steps needed to decarbonize passenger and freight travel, which make up the largest contributor to greenhouse gases. While they advised that “no single technology, policy, or behavioral change” is enough by itself to reach the target, eliminating tailpipe emissions would be a major factor.
“There ...
After the Southwest Research Institute-led Lucy mission flew past the asteroid Dinkinesh, the team discovered that it is even more “marvelous” as its newly discovered satellite is now shown to be a double-lobed moonlet. As NASA’s Lucy spacecraft continued to return data acquired during its first asteroid encounter on Nov. 1, 2023, the team discovered that Dinkinesh’s surprise satellite is itself a contact binary, made of two smaller objects touching each other.
In the first image of Dinkinesh and its satellite taken at closest approach, the two lobes of the contact binary lined up, one behind the other, ...
New maps of more than 1,000 deep-seated landslides in the Puget Lowlands of Washington State provide evidence of the last major earthquake along the Seattle Fault about 1,100 years ago—and may also hold traces of older earthquakes along the fault.
Clusters of landslides offer a potential record of earthquakes, if researchers can determine when the landslides occurred. The new study published in the Bulletin of the Seismological Society of America combines information about the location of these Puget Lowlands landslides along with new dates obtained from measuring the surface roughness of the landslides.
The ...
Researchers led by Mroj Alassaf at the Fred Hutchinson Cancer Research Center in the United States have discovered a link between obesity and neurodegenerative disorders like Alzheimer’s disease. Using the common fruit fly, the research shows that a high-sugar diet — a hallmark of obesity — causes insulin resistance in the brain, which in turn reduces the ability to remove neuronal debris, thus increasing the risk of neurodegeneration. Publishing November 7th in the open access journal PLOS Biology, the research will impact therapies designed to reduce the risk of developing ...
A common, cat-borne parasite already associated with risk-taking behavior and mental illness in humans may also contribute to exhaustion, loss of muscle mass, and other signs of “frailty” in older adults, suggests a study published Nov. 6 in the Journal of Gerontology: Medical Science.
The research, by an international team of scientists including University of Colorado Boulder, University of Maryland School of Medicine and the University of A Coruña in Spain, is the latest to explore how the tiny, single-celled ...
