OP0013 Pregnancy outcomes in dmard exposed patients with juvenile idiopathic arthritis – results of the biologic register jumbo
Authors: P. Drechsel, J. Klotsche, M. Niewerth, G. Horneff, K. Minden
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Juvenile idiopathic arthritis (JIA) often persists into adult life. Young women and men with JIA are often still exposed to disease modifying anti-rheumatic drugs (DMARDs). Little is known about the impact of DMARDs on pregnancy and its outcome, and there has been no approved DMARD for pregnant or lactating women so far. <h3>Objectives</h3> To investigate the course and outcome of pregnancies in female JIA patients and male JIA patients with pregnant partners who were exposed to DMARDs. <h3>Methods</h3> In the JIA biologic registry JuMBO (Juvenile arthritis MTX/Biologics long-term Observation), patients (or partners of patients) with pregnancies were identified. Standardised patient interviews were conducted and the course and outcome of pregnancy inquired. In addition, prospectively collected physician-reported data were considered in the analysis. <h3>Results</h3> Out of the 1300 patients enrolled in JuMBO, a total of 222 pregnancies in 116 women and in 25 partners of men with JIA were reported. Until January 2018, information was available for 149 pregnancies of 96 women with JIA and for 34 pregnancies of 20 male patients with pregnant partners. The majority of the 96 women had polyarticular JIA (75%). The median age at first conception was 24 years (ys, IQR 20–27) and the median disease duration was 14 ys (IQR 9–18). All women were ever exposed to DMARDs, 84% to a biological (b) DMARD. Among the 149 pregnancies, 64 occurred upon DMARD exposure (29 bDMARDs, 23 bDMARDs plus synthetic (s)DMARDs, 12 sDMARDs). DMARDs were discontinued in most exposed patients 6 weeks (median, IQR 4–9) after conception. In the groups of pregnancy exposed (n=64) and unexposed (n=85) to a DMARD at conception were the outcomes as follows: 36 and 64 live births, 16 and 6 elective pregnancy terminations, 8 and 12 spontaneous abortions, 2 and 0 extra-uterine gravidity, and 0 and 1 stillbirth, respectively. Among the 100 pregnancies with live births, most frequent complications were gestational diabetes in 9 cases and bleeding in 7 cases. Three women suffered from preeclampsia. Twelve children were born before the 37th week of gestation (5 (13.9%) of exposed and 7 (10.9%) of unexposed mothers) and 38 were born by Caesarean section. Six children were born with malformations, of which four are to be considered as major anomalies according to the EUROCAT classification<sup>1</sup> (2 (5.5%) in exposed patients and 2 (3.1%) in unexposed patients). Of the 34 pregnancies in partners of male patients, in 26 cases the expectant fathers had been exposed to DMARDs at conception. Most pregnancies (29/34, 85.2%) resulted in a live birth, 3 (8.8%) ended in a spontaneous abortion and 1 (2.9%) pregnancy was terminated. Two (6.9%) children were born with congenital malformation <h3>Conclusions</h3> Women and men with JIA who are still undergoing treatment in young adulthood often become pregnant or procreate children under medication, why more information on drug safety in pregnancy is needed. For this, more patient data must be evaluated in connexion with therapy, disease activity and the JIA category. <h3>Reference</h3> [1] European Surveillance of Congenital Anomalies, EUROCAT Guide 1.3, chapter 3.3: Coding of EUROCAT subgroups of congenital anomalies. Available from www.eurocat-network.eu (Accessed 30 January 2018). <h3>Acknowledgements</h3> JuMBO register: Joint unconditional grant from Pfizer, Abbvie and Roche. <h3>Disclosure of Interest</h3> P. Drechsel: None declared, J. Klotsche: None declared, M. Niewerth: None declared, G. Horneff Grant/research support from: Abbvie, MSD, Pfizer, Chugai, Roche, K. Minden Grant/research support from: Abbvie, Pfizer, Chugai, Roche