FRI0544 THE EFFECT OF PATERNAL EXPOSURE TO IMMUNOSUPPRESSIVE DRUGS ON SEXUAL FUNCTION, REPRODUCTIVE HORMONES, FERTILITY, PREGNANCY AND OFFSPRING OUTCOMES: A SYSTEMATIC REVIEW
Authors: L. F. Perez, R. Dolhain, S. Vorstenbosch, W. Bramer, E. Van Puijenbroek, J. Hazes, B. Te Winkel
Journal: Annals of the Rheumatic Diseases (2020)

Background: Information regarding the possible influence of immunosuppressive drugs on male sexual function and reproductive outcomes is scarce. Men diagnosed with immune-mediated diseases and a wish to become a father represent an important neglected population since they lack vital information to make balanced decisions about their treatment. Objectives: To systematically review the literature for the influence of paternal immunosuppressive drug use on many aspects of male sexual health, such as sexual function, fertility, pregnancy outcomes and on their offspring health outcome. Methods: A systematic literature search was performed in the bibliographic databases: Embase (via Elsevier embase.com), MEDLINE ALL via Ovid, Cochrane Central Register of Trials (via Wiley) and Web of Science Core Collection. Additionally, Google Scholar and the Clinical trial registries of Europe and the USA were searched. The databases were searched from inception until August 31th 2019. The searches combined keywords regarding male sexual function and fertility, pregnancy outcomes and offspring’s health with a list of immunosuppressive drugs. Studies were included if they were published in English and if they included original data on male human exposure to immunosuppressive drugs. Results: A total of 5867 references were identified among which we identified 163 articles fulfilling the eligibility criteria. Forty nine articles included pregnancy and offspring outcomes and 116 articles included sexual health outcomes. With the exception of large Scandinavian cohorts, most of the identified articles included a small number of participants. While a clear negative effect on sperm quality was evident for sulfasalazine and cyclophosphamide a dubious effect was identified for colchicine, methotrexate and sirolimus. In 3 articles exposure to TNF-a inhibitors in patients diagnosed with ankylosing spondylitis resulted in improved sperm quality. The information regarding pregnancy and offspring outcomes was scant but no large negative effect associated with paternal immunosuppressive drug exposure was reported. Conclusion: Evidence regarding the safety of immunosuppressive drugs in men with a wish to become a father is inconclusive. The lack of standardization on how to evaluate and report male sexual function, fertility and reproduction as study outcomes in men exposed to immunosuppressive drugs is an important contributor to this result. Future research on this topic is needed and should be preferably done using standardized methods. Figure 1. Flow diagram for study selection. Disclosure of Interests: Luis Fernando Perez: None declared, Radboud Dolhain Grant/research support from: unrestricted grant from UCB Pharma, Saskia Vorstenbosch: None declared, Wichor Bramer: None declared, Eugène van Puijenbroek: None declared, Johanna Hazes: None declared, Bernke te Winkel: None declared