DESCRIPTIVE ANALYSIS OF PREGNANCY, DELIVERY, AND LACTATION IN PATIENTS WITH RHEUMATOID ARTHRITIS FROM THE IORRA COHORT

Background: Rheumatoid Arthritis (RA) is common in women with reproductive age. For this reason, RA treatment during pregnancy and lactation is very important. In recent years, the use of biologic disease-modifying antirheumatic drugs (bDMARDs) has become common in RA treatment (1), treatment during pregnancy and lactation has changed drastically (2,3). Objectives: To investigate the pregnancy, delivery and lactation status of RA patients and treatment during that period in daily practice. Methods: The IORRA cohort is a large, single institute-based, observational cohort of RA patients established at Institute of Rheumatology, Tokyo Women’s Medical University, in 2000. We identified female RA patients aged 20-49 years who answered ‘pregnant’ or ‘delivered’ in the IORRA survey in 2010-2016 and whose pregnancies were confirmed in the medical records. We examined the Disease Activity Score with 28 joint count (DAS28)-CRP, medication use situation, the outcome of pregnancy, and lactation in those patients. Results: A total of 101 patients and 143 pregnancies were confirmed, of which 136 outcomes of pregnancy could be confirmed in the medical records. Among 136 confirmed pregnancy cases, there were 106 births and 30 miscarriages. Among 106 births, 4 cases (3.8%) were birth defects that could be confirmed in the medical records. The average age at pregnancy was 34.2±3.7 years and 36.1±3.3 years in delivered and miscarried cases, respectively. Miscarried cases were significantly older pregnancies (p=0.01). Of the 106 births, 65 birth weeks were confirmed, with an average of 37.9±1.8 weeks. The number of preterm delivery was 11 cases (16.9%). The average birth weight of 59 babies whose birth weight could be confirmed was 2699±517 g. There were 21 cases (35.6%) of low birth weight infants. The proportion of patients in DAS28-CRP remission was 73.1% before pregnancy, 61.6% during pregnancy, and 68.0% 1 year after delivery. Drugs used before pregnancy were glucocorticoid (48.8%), non-steroidal anti-inflammatory drugs (14.2%), conventional synthetic DMARDs (24.8%), and bDMARDs (48.0%). Etanercept accounted for 90% of bDMARDs. Among taking bDMARDs patients, 73.8% were discontinued after the pregnancy, and 26.2% were continued during pregnancy. Among those patients who continued bDMARDs, lactating patients were 12/26 (46.2%) cases after delivery, 10/30 (33.3%) cases in six months after delivery, and 7/36 (19.4%) cases in 1 year after delivery, respectively. Conclusion: The actual situation of pregnancy, delivery, and lactation in RA patients was revealed. Especially, bDMARDs were used at relatively high rates in RA patients who wish to have a child. References: [1]Lancet. 2017;10;389:2338-2348. [2]Semin Arthritis Rheum. 2019;49:S32-S35. [3]Rheumatology. 2016;55:1693-7. Disclosure of Interests: Moeko Ochiai: None declared, Eiichi Tanaka Consultant of: ET has received lecture fees or consulting fees from Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Speakers bureau: ET has received lecture fees or consulting fees from Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Eisuke Inoue Speakers bureau: EI has received speaker fee from Bristol-Meyers, Pfizer, Merck serono., Mai Abe: None declared, Eri Sugano: None declared, Naohiro Sugitani: None declared, Kumiko Saka: None declared, higuchi yoko: None declared, Rei Yamaguchi: None declared, Naoki Sugimoto: None declared, Ikari Katsunori Speakers bureau: KI has received speaker’s fee from Asahi Kasei Pharma Corp., Astellas Pharma Inc., AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eis, ai Co., Ltd., Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., Kaken Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Corp.Pfizer Japan Inc., Takeda Pharmaceutical Co. Ltd., Teijin Pharma Ltd and UCB Japan Co. Ltd., Ayako Nakajima Grant/research support from: AN has received research grants from Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Consultant of: AN has consultant fee from Nippon Kayaku Co. Ltd., Speakers bureau: AN has received speaker’s fee from AbbVie Japan GK, Actelion Pharmaceuticals Japan LTD., Asahi Kasei Pharma Co., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Hisamitsu Pharmaceutical Co. Inc., Kyorin Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Co., Otsuka Pharmaceutical Co. Ltd., Pfizer Japan Inc., and Teijin Pharma Ltd., Atsuo Taniguchi: None declared, Hisashi Yamanaka Grant/research support from: HY has received research grant or speaker fee from AbbVie, Astellas, Ayumi, Behringer, Bristol-Meyers, Chugai, Daiichi-Sankyo, Eisai, Kaken, Nippon-Shinyaku, Novartis, Ono, Pfizer, Taisyo-Toyama, Takeda, Tanabe-Mitsubishi, Teijin Pharma, Torii, UCB, YLbio., Speakers bureau: HY has received research grant or speaker fee from AbbVie, Astellas, Ayumi, Behringer, Bristol-Meyers, Chugai, Daiichi-Sankyo, Eisai, Kaken, Nippon-Shinyaku, Novartis, Ono, Pfizer, Taisyo-Toyama, Takeda, Tanabe-Mitsubishi, Teijin Pharma, Torii, UCB, YLbio., masayoshi harigai Grant/research support from: AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., and Teijin Pharma Ltd. MH has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kissei Pharmaceutical Co., Ltd., Oxford Immuotec, Pfizer Japan Inc., and Teijin Pharma Ltd. MH is a consultant for AbbVie, Boehringer-ingelheim, Kissei Pharmaceutical Co., Ltd. and Teijin Pharma.