Effect of treat-to-target strategies on maternal and neonatal outcomes of rheumatoid arthritis: a multicentre real-world ANSWER cohort study
Authors' conclusion
T2T management, including selective continuation of bDMARDs, was associated with favourable maternal disease control and reassuring pregnancy outcomes.
Study context
- Population
- Pregnancies in women with rheumatoid arthritis (RA), multicentre ANSWER cohort (2013–2023), eight Japanese academic institutions
- Participants
- 118 pregnancies
- Exposure
- Continuation vs discontinuation of biologic disease-modifying antirheumatic drugs (bDMARDs) during pregnancy
- Continued bDMARDsn = 35
- Discontinued bDMARDsn = 24reference
- Outcome
- Disease activity (DAS28-CRP), treatment patterns and pregnancy outcomes
- Follow-up
- Preconception, each trimester and postpartum
Methodological detailsmulticentre, real-world, observational
- Multicentre
- Real-world
- Observational
Main finding
As reported in the abstract
Full-term deliveries
92.8%
Median birthweight
2949 g
Remission or low disease activity maintained throughout pregnancy
∼85%
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| DAS28-CRP during second and third trimesters (continued vs discontinued bDMARDs)Continued bDMARDs vs Discontinued bDMARDs · second trimester; significantly lower in continued | P = 0.007 |
| DAS28-CRP during second and third trimesters (continued vs discontinued bDMARDs)Continued bDMARDs vs Discontinued bDMARDs · third trimester; significantly lower in continued | P = 0.0002 |
Other treatment associations
- Salazosulfapyridine use correlated with increased birth weight
- P = 0.003
- Salazosulfapyridine use and gestational age
- P = 0.051
- Etanercept or certolizumab pegol use associated with favourable disease control
- GC use associated with increased disease activity
Safety
Adverse maternal or neonatal outcomes with tocilizumab (n = 6) or abatacept (n = 2)
- Not associated with adverse maternal or neonatal outcomes
Original publication
Effect of treat-to-target strategies on maternal and neonatal outcomes of rheumatoid arthritis: a multicentre real-world ANSWER cohort study. Rheumatology (Oxford). Published 24 October 2025. doi:10.
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