SAT0136 CONSISTENCY WITH INTERNATIONAL GUIDELINES REGARDING MOTHERS WITH RHEUMATOLOGIC DISEASES EXPOSED TO TUMOUR NECROSIS FACTOR INHIBITORS (TNFI) DURING THE ANTE- AND POSTNATAL PERIODS AND CHANGE OVER TIME
Authors: Stephanie Bond, Laurel Young, Katherine Poulsen, Helen L. Barrett, Andrew L. Taylor, Claire Barrett
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Many women with rheumatologic diseases require ongoing treatment with TNFi during pregnancy to maintain remission or low disease activity. Until recently, there has been a paucity of published evidence regarding the safe use of these medications during the ante- and postnatal periods to guide clinical practice. <h3>Objectives</h3> To observe compliance with current guidelines for TNFi therapy in Australian women with rheumatologic diseases during the ante- and postnatal periods and change over time. <h3>Methods</h3> All Australian women with rheumatologic diseases, exposed to biologics (bDMARDs) and targeted synthetic disease modifying antirheumatic drugs (tsDMARDs) during the preconception, antenatal and/or postpartum periods were eligible to participate in the Pregnancy Exposed to Biological (PEB) study. Commencing in 2015, recruitment was via invitation from patient's treating rheumatologists, community groups, and social media. Following self-referral to the study, retrospective data was collected, including rheumatologic condition and management recommendations made by health professionals. <h3>Results</h3> Preliminary data is available for 37 infants born to 29 mothers from Feb 2009-Dec 2018. Of these, 32 women received TNFi. We assessed 3 outcomes – TNFi continuation during pregnancy, TNFi continuation during lactation and vaccination practice in infants exposed to TNFi. Women exposed to non-TNFi bDMARDs and tsDMARDs were excluded from this abstract, as these are not recommended for use during the perinatal period (2). Specialist Society Guidelines from the British Society of Rheumatology and the British Health Professional in Rheumatology were published in 2016 regarding the safety of TNFi during pregnancy (2). Prior to guideline publication, 67% (n=16/24) of the women in PEB ceased their TNFi pre-conception. Of those in PEB who became pregnant subsequent to guideline publication, only 25% (n=2/8) ceased TNFi pre-conception. Overall, 40.6% (n=13/32) women received a TNFi during the antenatal period consistent with guidelines, which improved from 33.3% (n=8/24) pre-publication, to 62.5% (n=5/8) post publication. 84.4% (n=27/32) women exposed to TNFi breastfed their infants. Prior to availability of evidence regarding the safety of TNFi during lactation, 79.2% (n=19/24) of infants were breastfed. After publication, 100% (n=8/8) infants exposed to TNFi were breastfed. In total, 96.9% (n=31/32) of the infants exposed to TNFi in PEB were vaccinated. Rotavirus vaccine should have been delayed in 43.8% (n=14/32) infants, but was not. 9.4% (n=3/32) infants had live vaccines deferred until only 3 months; 3.1% (n=1/32) infants had live vaccines unnecessarily delayed. Only 3.1% (n=1/32) infants had live vaccines appropriately delayed until 7 months. Compliance with vaccination recommendations increased from 43.5% (n=10/24) pre-publication to 62.5% (n=5/8) post publication of guidelines. <h3>Conclusion</h3> Preliminary data from PEB suggests that there has been a shift in practice following the publication of Specialist Society Guidelines, with increasing numbers of women continuing TNFi therapy during pregnancy and the postpartum period, in keeping with current evidence. Compliance with vaccination recommendations could be improved to be more consistent with published international guidelines. <h3>Reference</h3> [1] Flint J, et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford). 2016;55(9):1693-7. <h3>Acknowledgement</h3> The PEB study is supported by an unrestricted educational grant from UCB <h3>Disclosure of Interests</h3> Stephanie Bond Grant/research support from: Pregnancy Exposed to Biologicals Study supported by UCB, Laurel Young Grant/research support from: Pregnancy Exposed to Biologicals Study supported by UCB, Katherine Poulsen Grant/research support from: Pregnancy Exposed to Biological Study supported by UCB, Helen L Barrett Grant/research support from: Pfizer Australia Cardiovascular lipid research grant, Andrew L Taylor Grant/research support from: Pregnancy Exposed to Biologicals Study supported by UCB, Claire Barrett Grant/research support from: Pregnancy Exposed to Biologicals Study supported by UCB, Speakers bureau: UCB Breakfast meeting chair Australian Rheumatology Association Annual Scientific Meeting 05/18