P116 A systematic review of the safety of non-tumour necrosis factor inhibitor and targeted synthetic drugs in rheumatic disease in pregnancy

Abstract

Abstract Background Despite increasing evidence to support safe use of tumour necrosis factor inhibitor (TNFi) drugs in pregnancy, there remains a paucity of evidence regarding non-TNFi and targeted synthetic disease modifying anti-rheumatic drugs (tsDMARDs) in pregnancy. Therefore, we conducted a systematic review to summarise use of these drugs in pregnancy and breastfeeding. Methods Systematic search of databases including; EMBASE, Pubmed (MEDLINE), and Cochrane up to December 2018 using keywords including; commonly prescribed non-TNFi and tsDMARDs, pregnancy, conception/pre-conception, lactation/breastfeeding, childhood and vaccination/infection. Results From an initial screen of 700 papers, n = 92 full text papers were included in the final analysis. A summary of findings from known outcomes of pregnancy and breastfeeding exposures as well as long-term follow-up of infants where available are shown in Table 1. Overall, this data does not identify an increased risk of adverse pregnancy outcomes with these drugs in this population of patients. Conclusion These findings do not suggest an increased risk of non-TNFi and tsDMARDs in pregnancy. Given that the total number of exposures, however, remain limited these drugs should only be considered in pregnancy if the benefit of maintaining disease control in the mother justifies any potential risk to the fetus. This body of evidence will be useful when counselling women about the potential risks of using these types of drugs during pregnancy and breastfeeding period as well as following accidental exposure to drugs at conception. Disclosures H. Nguyen None. K. Ahmed None. J. Flint None. I. Giles None.