P272 Pregnancy outcomes in women receiving biological therapy for axial spondyloarthritis
Authors: Brandie Emma L , Jones Gareth T 
Published: April 2022

Abstract

Background/Aims
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease affecting the spine and sacroiliac joints. It is typically diagnosed before the age of thirty-five in patients presenting with pain and stiffness of the lower back. Treatment of axSpA is multidisciplinary and medical management initially consists of non-steroidal anti-inflammatory medications. For patients with high disease activity or poor symptomatic control, treatment may be escalated to biological therapies including, tumour necrosis factor (TNF) alpha inhibitors. Thus, treatment with these powerful medications is likely to coincide with the time that patients may wish to start a family. Currently, there is very limited evidence regarding the safety of biological therapies during pregnancy and the advice to patients is unclear. The aim of this paper is to identify the current evidence regarding pregnancy outcomes following exposure to biological therapy during pregnancy for the treatment of axSpA.

Methods
Methods: A literature search was conducted through Ovid Medline and Embase to identify relevant studies in line with a patient population, intervention, comparator, and outcomes (PICO) model identified prior to this study. An adapted version of the PRISMA 2020 flow diagram guided screening of manuscripts identified during database searches. Data gathered were summarised in a narrative review.

Results
From 15,121 papers identified, 101 were assessed for eligibility and six full papers were included in this study. Five of these studies reported 117 pregnancy outcomes following exposure to TNF-alpha inhibitors (adalimumab, etanercept, certolizumab pegol) for treatment of axSpA during pregnancy. Of these, five pregnancies were reported to have birth defects, for example cerebral ventricle dilatation and premature birth. The final study reported a high proportion of Caesarean sections among women treated with TNF-alpha inhibitors: 83 deliveries (61%) from 136 pregnancies.

Conclusion
There is very little published evidence on the safety of TNF-alpha inhibitors during pregnancy for axSpA and no papers were identified describing pregnancy outcomes in non-TNF biologics. Some additional literature was identified, examining biologic use in pregnancy across a variety of other rheumatological conditions, although it was often not possible to extract data on axSpA separately.
However, existing evidence suggests no increased risk of adverse pregnancy outcomes associated with TNF inhibition in axSpA. There is some evidence that pregnant women may be more likely to undergo Caesarean section rather than vaginal delivery, although it is not clear whether this is due to increased elective or emergency Caesarean section. This review highlights the need for more studies to be conducted on this topic. This would enable more robust evidence-based guidelines to be produced and implemented confidently in clinical practice.
Funding Statement: ELB supported by University of Aberdeen Summer Research Scholarship Programme.

Disclosure
E.L. Brandie: None. G.T. Jones: None.