Patterns of medication use during pregnancy in rheumatoid arthritis

Bindee Kuriya, Sonia Hernández-Díaz, Jun Liu, Bonnie L. Bermas, Gregory Daniel, Daniel H. Solomon

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Objective: To characterize therapies prescribed during pregnancy to women with rheumatoid arthritis (RA). Methods: We conducted a cohort study of women with RA with pregnancies using health care utilization data from 2002-2008. We examined the distribution of RA drugs by therapeutic classes, including nonsteroidal anti-inflammatory drugs (NSAIDs)/coxibs, glucocorticoids, nonbiologic disease-modifying antirheumatic drugs (DMARDs), and biologic DMARDs, during 90-day pregnancy trimesters and the 180 days prior to pregnancy. Drugs were characterized according to the Food and Drug Administration risk classification system. Differences in exposure by period were determined by chi-square tests. Results: A total of 393 pregnancies were identified among 34,169 women with RA. Seventy-two percent of pregnancies ended in a delivery. Approximately 24% of women with RA received a DMARD during preconception. At any point during pregnancy, 23% of women with deliveries were dispensed >1 DMARD and the proportion of use declined from the first to the third trimester (P = 0.03). Similar to DMARD therapy, use of NSAIDs/coxibs and exposure to category D/X medications were significantly lower compared to prepregnancy use (P > 0.05). In contrast, more women were prescribed glucocorticoids during pregnancy than before pregnancy. Use of biologics occurred in 12.5% of pregnancies. Compared to women with deliveries, women who experienced abortions were more frequently exposed to NSAIDs/coxibs (P > 0.05). Dispensing of category D/X medications was also higher in women with spontaneous abortions and primarily involved methotrexate (P > 0.05). Conclusion: Approximately 24% of women with RA received a DMARD in the 180 days before conception, and the proportion dropped during pregnancy. Glucocorticoid use remained high throughout pregnancy. Our results suggest that continued efforts directed at counseling women and their physicians about the potential risks/benefits of RA therapies during pregnancy are warranted.

Original languageEnglish (US)
Pages (from-to)721-728
Number of pages8
JournalArthritis Care and Research
Volume63
Issue number5
DOIs
StatePublished - May 1 2011

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Rheumatoid Arthritis
Pregnancy
Antirheumatic Agents
Cyclooxygenase 2 Inhibitors
Glucocorticoids
Anti-Inflammatory Agents
Pharmaceutical Preparations
Patient Acceptance of Health Care
Women Physicians
Pregnancy Trimesters
Third Pregnancy Trimester
Spontaneous Abortion
United States Food and Drug Administration
Chi-Square Distribution
Biological Products
Methotrexate
Counseling
Cohort Studies
Therapeutics
Drug Therapy

ASJC Scopus subject areas

  • Rheumatology

Cite this

Kuriya, B., Hernández-Díaz, S., Liu, J., Bermas, B. L., Daniel, G., & Solomon, D. H. (2011). Patterns of medication use during pregnancy in rheumatoid arthritis. Arthritis Care and Research, 63(5), 721-728. https://doi.org/10.1002/acr.20422

Patterns of medication use during pregnancy in rheumatoid arthritis. / Kuriya, Bindee; Hernández-Díaz, Sonia; Liu, Jun; Bermas, Bonnie L.; Daniel, Gregory; Solomon, Daniel H.

In: Arthritis Care and Research, Vol. 63, No. 5, 01.05.2011, p. 721-728.

Research output: Contribution to journalArticle

Kuriya, B, Hernández-Díaz, S, Liu, J, Bermas, BL, Daniel, G & Solomon, DH 2011, 'Patterns of medication use during pregnancy in rheumatoid arthritis', Arthritis Care and Research, vol. 63, no. 5, pp. 721-728. https://doi.org/10.1002/acr.20422
Kuriya, Bindee ; Hernández-Díaz, Sonia ; Liu, Jun ; Bermas, Bonnie L. ; Daniel, Gregory ; Solomon, Daniel H. / Patterns of medication use during pregnancy in rheumatoid arthritis. In: Arthritis Care and Research. 2011 ; Vol. 63, No. 5. pp. 721-728.
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abstract = "Objective: To characterize therapies prescribed during pregnancy to women with rheumatoid arthritis (RA). Methods: We conducted a cohort study of women with RA with pregnancies using health care utilization data from 2002-2008. We examined the distribution of RA drugs by therapeutic classes, including nonsteroidal anti-inflammatory drugs (NSAIDs)/coxibs, glucocorticoids, nonbiologic disease-modifying antirheumatic drugs (DMARDs), and biologic DMARDs, during 90-day pregnancy trimesters and the 180 days prior to pregnancy. Drugs were characterized according to the Food and Drug Administration risk classification system. Differences in exposure by period were determined by chi-square tests. Results: A total of 393 pregnancies were identified among 34,169 women with RA. Seventy-two percent of pregnancies ended in a delivery. Approximately 24{\%} of women with RA received a DMARD during preconception. At any point during pregnancy, 23{\%} of women with deliveries were dispensed >1 DMARD and the proportion of use declined from the first to the third trimester (P = 0.03). Similar to DMARD therapy, use of NSAIDs/coxibs and exposure to category D/X medications were significantly lower compared to prepregnancy use (P > 0.05). In contrast, more women were prescribed glucocorticoids during pregnancy than before pregnancy. Use of biologics occurred in 12.5{\%} of pregnancies. Compared to women with deliveries, women who experienced abortions were more frequently exposed to NSAIDs/coxibs (P > 0.05). Dispensing of category D/X medications was also higher in women with spontaneous abortions and primarily involved methotrexate (P > 0.05). Conclusion: Approximately 24{\%} of women with RA received a DMARD in the 180 days before conception, and the proportion dropped during pregnancy. Glucocorticoid use remained high throughout pregnancy. Our results suggest that continued efforts directed at counseling women and their physicians about the potential risks/benefits of RA therapies during pregnancy are warranted.",
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