Antirheumatic drugs in reproduction, pregnancy, and lactation: a systematic literature review informing the 2024 update of the EULAR recommendations
Authors' conclusion
This SLR provides up-to-date evidence to guide the 2024 update of the European Alliance of Associations for Rheumatology recommendations for the use of antirheumatic drugs in reproduction, pregnancy, and lactation.
Study context
- Population
- Studies on antirheumatic drugs in reproduction, pregnancy and lactation, including men255 articles included
Methodological detailsinforming the 2024 update of the EULAR recommendations, meta-analysis of adjusted risk estimates where sufficient data, 6680 articles screened
- Informing the 2024 update of the EULAR recommendations
- Meta-analysis of adjusted risk estimates where sufficient data
- 6680 articles screened
Pooled result
As reported in the abstract
- Meta-analyses with adjusted risk estimates: Adverse pregnancy outcomes (APOs) or serious infant infections not associated with tumour necrosis factor inhibitor (TNFi) use
- Data on non-TNFi biologic disease-modifying antirheumatic drugs (bDMARDs) did not raise concerns
- Oral GC: dose-dependent association with increased risk of preterm birth
- NSAID use could reversibly reduce fecundability
- Lactation: available data on various bDMARDs reassuring
- Men: MTX and most other drugs did not reveal adverse effects on sperm quality or birth outcomes
- CYC the only drug causing dose-dependent irreversible infertility
Safety
- No serious adverse effects to rotavirus live vaccination reported in bDMARD-exposed infants
- BCG vaccination safety in TNFi-exposed infants could be a concern in first 6 months of life
Original publication
Antirheumatic drugs in reproduction, pregnancy, and lactation: a systematic literature review informing the 2024 update of the EULAR recommendations. Ann Rheum Dis. Published 16 April 2025. doi:10.
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