HCQ remains the antimalarial of choice in women planning a pregnancy with rheumatic disease in need of treatment and should be continued during pregnancy (LOE 1 ++, GOR A, SOA 100%). Treatment with MMF should be stopped at least 6 weeks before a planned pregnancy (LOE 3, GOR D, SOR 100%). Golimumab is unlikely to be harmful in the first trimester (LOE 4, GOR D, SOA 97.9%). I.G. Women on LEF considering pregnancy should stop and undergo cholestyramine washout before switching to alternative medication compatible with pregnancy (LOE 2+, GOR C, SOA 100%). Should it be stopped pre-conception? An accompanying description of evidence and full recommendations are given in the full guideline, available as Men should not be discouraged from taking HCQ while trying to conceive (LOE 2−, GOR D, SOA 98.9%). M . There are no data relating to paternal exposure to calcium channel blockers, but they are unlikely to cause harm (LOE4, GOR D, SOA 98.9%). The BSR guidelines expand and update previous consensus recommendations and systematically review all current evidence on use of various anti-rheumatic drugs before/during pregnancy and breastfeeding in patients with rheumatic disease. C.G. All rights reserved. Panchal Oxford University Press is a department of the University of Oxford. Biologic therapies are not without potential risk, and hence it is imp… Disclosure statement : K.S. Given their biological half-life in bone of up to 10 years and no evidence of harm from limited reports of their use in pregnancy, a pragmatic recommendation is that they should be stopped 3 months before pregnancy (LOE 4, GOR D, SOA 98.4%). A Doria Based on limited evidence, RTX is compatible with paternal exposure (LOE 2−, GOR D, SOA 98.4%). Non-selective NSAIDs are compatible with paternal exposure (LOE 2−, GOR D, SOA 98.9%). Limited evidence has not shown RTX to be teratogenic and only second-/third-trimester exposure is associated with neonatal B cell depletion. et al.  For Permissions, please email: journals.permissions@oup.com. M.K. c Conception may be enhanced by stopping SSZ for 3 months prior to conception. LDA may be continued throughout pregnancy and National Institute for Health and Care Excellence guidelines (August 2010) for hypertension in pregnancy advise treatment with LDA (for prophylaxis of pre-eclampsia) until delivery (LOE 1+, GOR B, SOA 100%). et al. Panchal The use of warfarin in pregnancy is associated with increased foetal risk throughout pregnancy and should only be considered in exceptional circumstances (LOE 1−, GOR B, SOA 100%). BSR and BHPR guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs Rheumatology (Oxford). Professor Ian Giles and Professor Caroline Gordon describe best practice in the care of women of child-bearing age with inflammatory rheumatic diseases before, during, and after pregnancy The guidelines are published Monday 11 January in the Rheumatology Journal and are … CSA is compatible throughout pregnancy at the lowest effective dose (LOE 1, GOR B, SOA 100%). 2016 Sep;55(9):1693-7. doi: 10.1093/rheumatology/kev404. Objective: To develop an evidence-based guideline on contraception, assisted reproductive technologies (ART), fertility preservation with gonadotoxic therapy, use of menopausal hormone replacement therapy (HRT), pregnancy assessment and management, and medication use in patients with rheumatic and musculoskeletal … D.W. has received financial support for an independent PhD studentship from GlaxoSmithKline and Alere and acted as a consultant for Roche Diagnostics. Venlafaxine is compatible at conception and throughout pregnancy. IVIG is compatible with breastfeeding (LOE 4, GOR D, SOA 98.9%). There are no data relating to paternal exposure to selective serotonin reuptake inhibitors, but based on maternal compatibility, they are unlikely to be harmful (LOE 4, GOR D, SOA 98.4%). Based on limited evidence IFX, ETA and ADA are compatible with paternal exposure (LOE 2−, GOR D, SOA 98.9%). a Intermittent use advised, see main text for details. J There may be an increased risk of neonatal abstinence syndrome/short-term behavioural effects, but larger studies are needed to evaluate this finding (LOE 2+, GOR C, SOA 98.9%). Codeine is compatible peri-conception and throughout pregnancy. Østensen Mothers on CSA should not be discouraged from breastfeeding (LOE 3, GOR D, SOA 100%). Your comment will be reviewed and published at the journal's discretion. MTX cannot be recommended in breastfeeding because of theoretical risks and insufficient outcome data (LOE 4, GOR D, SOA 100%). • The 2012 BSR and BHPR guideline for the treatment of psoriatic arthritis with biologics20 • The 2016 BSR and BHPR guideline in prescribing drugs in pregnancy and breastfeeding21. Andreoli Based on limited data, women should not be discouraged from breastfeeding on selective serotonin reuptake inhibitors (LOE 4, GOR D, SOA 98.4%). MMF remains contraindicated during pregnancy (LOE 2−, GOR D, SOA 100%). Health professionals directly involved in managing patients with rheumatic disease in the UK who are or are planning to become pregnant and/or breastfeeding, men planning to conceive and patients who have accidentally conceived while taking these medications. Based on limited evidence, tacrolimus is compatible with paternal exposure (LOE 2−, GOR D, SOA 98.4%). The BSR issued guidelines for the treatment of adult psoriatic arthritis with biologic agents (particularly anti-TNF therapy). There is limited evidence on the use of ACEIs in breastfeeding. Is it compatible with breastfeeding? There are no data relating to paternal exposure to TCZ, but it is unlikely to be harmful (LOE 4, GOR D, SOA 97.9%). There are no data relating to paternal exposure to ABA, but it is unlikely to be harmful (LOE 4, GOR D, SOA 98.9%). Implementing guidelines Pregnancy and rheumatic diseases: best practice and prescribing considerations. on behalf of the BSR and BHPR Standards, Guidelines and Audit Working Group (2016). There is no human evidence of increased congenital abnormalities on LEF if washout is given. There are no data relating to paternal exposure to tramadol, but due to maternal compatibility, it is unlikely to be harmful (LOE 4, GOR D, SOA 98.9%). L . Nifedipine is compatible with breastfeeding (LOE 3, GOR D, SOA 100%). Target audience Health professionals directly involved in managing patients with rheumatic disease in the UK who are or are planning to become pregnant and/or breastfeeding, men … British Association of Dermatologists guidelines for biologic therapy for psoriasis 2017 5 Summary of drug compatibility in pregnancy and breastfeeding. Towards clinical data-driven eligibility criteria optimization for interventional COVID-19 clinical trials. has received educational support from Daiichi Sankyo. d Insufficient evidence regarding use for treatment of chronic pain in pregnancy. This Guidelines summary includes a summary table on prescribing anti-rheumatic drugs, analgesics and other drugs during pregnancy and breastfeeding. AZA is compatible with breastfeeding (LOE 2−, GOR D, SOA 99.5%). There are no data relating to paternal exposure to codeine, but due to maternal compatibility, it is unlikely to be harmful (LOE 4, GOR D, SOA 98.9%). BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part II: Analgesics and other drugs used in rheumatology practice. Methylprednisolone has rates of placental transfer similar to prednisolone with equivalent anti-inflammatory effects at 80% of prednisolone dose and would therefore be expected to be compatible with pregnancy, breastfeeding and paternal exposure (LOE 4, GOR D, SOA 93.7%). Hurrell AZA is compatible throughout pregnancy at ⩽2 mg/kg/day (LOE 2 ++, GOR B, SOA 100%). Andreoli There are no data on RTX use in breastfeeding (SOA 100%). Based on limited data, tramadol may be compatible with short-term use in breastfeeding (LOE 2−, GOR D, SOA 97.9%). More frequent monitoring is appropriate in patients at higher risk of toxicity (GRADE 2B, 97%). Flint, Julia et al. Unintentional exposure early in the first trimester is unlikely to be harmful (LOE 3, GOR D, SOA 98.9%). M J HCQ is compatible with breastfeeding (LOE 4, GOR D, SOA 98.9%). Østensen Certolizumab pegol is compatible with all three trimesters of pregnancy and has reduced placental transfer compared with other TNF inhibitors (TNFis) (LOE 2−, GOR D, SOA 97.9%). Brucato Amitriptyline is compatible with pregnancy (LOE 2+, GOR C, SOA 99.5%). 2020-11-16T15:54:00Z. Based on very limited evidence, LEF may be compatible with paternal exposure (LOE 4, GOR D, SOA 98.9%). Published by Oxford University Press on behalf of the British Society for Rheumatology. Østensen Where possible, recommendations are made regarding compatibility with paternal exposure. Østensen has undertaken consultancies and received honoraria from Bristol-Myers Squibb, GlaxoSmithKline, MedImmune, Merck Serono and UCB, has been a member of the speakers’ bureau for GlaxoSmithKline, UCB and Lilly and has received research grant support from UCB, but none of these activities have been related to the use of any specific drug in pregnancy. Lockshin Khamashta IVIG is compatible with pregnancy (LOE 1 ++, GOR A, SOA 100%). For full access to this pdf, sign in to an existing account, or purchase an annual subscription. "BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids". Tacrolimus is compatible throughout pregnancy at the lowest effective dose (LOE 2−, GOR D, SOA 99.5%). There are no data on anakinra use in breastfeeding (SOA 100%). New BSR Guidelines on Biologic Safe Use with Inflammatory Arthritis Save. Based on limited evidence, low-dose MTX may be compatible with paternal exposure (LOE 2+, GOR D, SOA 95.8%). For recommendations on prescribing anti-rheumatic drugs in pregnancy and breastfeeding, see the BSR and BHPR guideline part I [ 4]. M Copyright © 2020 British Society for Rheumatology. C.G. has received unit support from AbbVie, MSD, Roche, Bristol-Myers Squibb and Sobi, participated on advisory boards for Pfizer and received fees for participation in an educational meeting by UCB. There is no evidence to recommend the use of CYC in breastfeeding (LOE 4, GOR D, SOA 100%). A BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids Rheumatology (Oxford) . To provide evidence-based recommendations, which do not imply a legal obligation, for clinicians when prescribing anti-rheumatic drugs before/during pregnancy and breastfeeding that update previous recommendations [ 2 , 3 ]. At present, there are limited data on selective COX-2 inhibitors; they should therefore be avoided during pregnancy (LOE 2+, GOR D, SOA 98.9%). LactMed describes paracetamol as a good choice for analgesia and fever reduction in breastfeeding mothers (LOE 4, GOR D, SOA 100%). There are insufficient data to recommend amlodipine in pregnancy, but there is no evidence of harm during pregnancy and an absence of evidence during breastfeeding (LOE 3, GOR D, SOA 99.5%). If these drugs are continued later in pregnancy to treat active disease, then live vaccines should be avoided in the infant until 7 months of age (LOE 3, GOR D, SOA 98.9%). Non-selective NSAIDs are excreted into breast milk, but there is no published evidence of harm (LOE 4, GOR D, SOA 98.9%). Rivaroxaban and dabigatran cannot be recommended in pregnancy or breastfeeding due to a lack of human data and concerns from animal studies (LOE 4, GOR D, SOA 100%). Therefore, unintentional RTX exposure early in the first trimester is unlikely to be harmful (LOE 2−, GOR D, SOA 97.9%). M.N. Please check for further notifications by email. In the case of accidental pregnancy on low-dose MTX, the drug should be stopped immediately, folate supplementation (5 mg/day) continued and a careful evaluation of foetal risk carried out by local experts (LOE 4, GOR D, SOA 100%). Julia Flint, Sonia Panchal, Alice Hurrell, Maud van de Venne, Mary Gayed, Karen Schreiber, Subha Arthanari, Joel Cunningham, Lucy Flanders, Louise Moore, Amy Crossley, Neetha Purushotham, Amisha Desai, Madeleine Piper, Mohamed Nisar, Munther Khamashta, David Williams, Caroline Gordon, Ian Giles, on behalf of the BSR and BHPR Standards, Guidelines and Audit Working Group, BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding—Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids, Rheumatology, Volume 55, Issue 9, September 2016, Pages 1693–1697, https://doi.org/10.1093/rheumatology/kev404. in pregnancy and breastfeeding see the British Society of Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) guidelines part II [4]. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Specific questions were considered in relation to each drug. Funding : No specific funding was received from any funding bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article. Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review The Belgian Society of Radiology (BSR) aims to be the premier Belgian radiological society that represents its members at the national, international, federal and community level.It wants to be the unifying channel through which communication and advocacy is organised with the authorities, organisations and bodies that … The use of biologic therapies has transformed the management of inflammatory arthritis (IA). has received individual support to attend meetings from GlaxoSmithKline, UCB and Astra-Zeneca, chairing fees from Bristol-Myers Squibb and honoraria from GlaxoSmithKline/Human Genome Sciences, MedImmune, INOVA Diagnostics and Merck. on behalf of the BSR and BHPR Standards, Guidelines and Audit Working Group (2016). The British Society of Rheumatology (BSR) has released guidelines … L2 Part 2 of this guideline considers pain manage-BSR and BHPR guideline on prescribing drugs in pregnancy … RA during pregnancy: Some women find that the pain and swelling associated with RA improves throughout pregnancy. This situation should be avoided because active rheumatic disease is associated with adverse pregnancy outcomes [ 1 ] and there is growing evidence of drug safety in pregnancy. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. guideline, part 1, considers antimalarials, corticosteroids, DMARDs and immunosuppressive therapies and bio-logics. Funding : No specific funding was received from any funding bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article. Rheumatology . has received support from AbbVie and Pfizer to attend education meetings and received participation honoraria from MSD. There are no data relating to paternal exposure to anakinra, but it is unlikely to be harmful (LOE 4, GOR D, SOA 98.9%). Women should not be discouraged from breastfeeding on TNFis, but caution is recommended until further information is available (LOE 3, GOR D, SOA 98.4%). TCZ should be stopped at least 3 months before conception, but unintentional exposure early in the first trimester is unlikely to be harmful (LOE 3, GOR D, SOA 96.8%). There are insufficient data upon which to recommend bisphosphonates in pregnancy or to advise a specific time for them to be stopped pre-conception. Is it compatible with pregnancy? has received support from AbbVie and Pfizer to attend education meetings and received participation honoraria from MSD. For further information and caveats, see relevant recommendations and main text in executive summary and full guideline. There are no data on which to base a recommendation for paternal exposure to bisphosphonates (SOA 100%). Please check for further notifications by email. et al. Caution is advised with the use of codeine in breastfeeding due to the risk of CNS depression resulting from unpredictable metabolism of codeine to morphine (LOE 2+, GOR D, SOA 98.4%). M has received educational support from Daiichi Sankyo. Is it compatible with pregnancy? Østensen Limited evidence supports the use of sildenafil to treat PHT during pregnancy (LOE 3, GOR D, SOA 99.5%). Author information: (1)Division of Rheumatology, Hospital for Special Surgery, 535 E. 70th Street, New York, New York 10021, USA. Should it be stopped pre-conception? Based on limited evidence, LEF may not be a human teratogen but it is still not recommended in women planning pregnancy (LOE 2+, GOR C, SOA 100%). A f Unintentional first trimester exposure is unlikely to be harmful. Therapy: A fine conception -- BSR/BHPR guidelines on drugs in pregnancy. Prednisolone is compatible with breastfeeding (LOE 2−, GOR D, SOA 98.9%). There is insufficient evidence to recommend gabapentin for the treatment of chronic pain in breastfeeding (LOE 4, GOR D, SOA 100%). Difficult-to-treat rheumatoid arthritis: contributing factors and burden of disease, A rare case of small-vessel necrotizing vasculitis of the bone marrow revealing granulomatosis with polyangiitis, Defining colchicine resistance/intolerance in patients with familial Mediterranean fever: a modified-Delphi consensus approach, Real-world single centre use of JAK inhibitors across the rheumatoid arthritis pathway, The management of Sjögren’s syndrome: British Society for Rheumatology guideline scope, About the British Society for Rheumatology, Recommendations for corticosteroids in pregnancy and breastfeeding, Recommendations for HCQ in pregnancy and breastfeeding, Recommendations for MTX in pregnancy and breastfeeding, Recommendations for SSZ in pregnancy and breastfeeding, Recommendations for LEF in pregnancy and breastfeeding, Recommendations for AZA in pregnancy and breastfeeding, Recommendations for CSA in pregnancy and breastfeeding, Recommendations for tacrolimus in pregnancy and breastfeeding, Recommendations for CYC in pregnancy and breastfeeding, Recommendations for MMF in pregnancy and breastfeeding, Recommendations for IVIG in pregnancy and breastfeeding, Recommendations for anti-TNF medications in pregnancy and breastfeeding, Recommendations for rituximab (RTX) in pregnancy and breastfeeding, Recommendations for tocilizumab (TCZ) in pregnancy and breastfeeding, Recommendations for anakinra in pregnancy and breastfeeding, Recommendations for abatacept (ABA) in pregnancy and breastfeeding, Recommendations for belimumab (BEL) in pregnancy and breastfeeding, https://doi.org/10.1093/rheumatology/kev404, Receive exclusive offers and updates from Oxford Academic. ESC Clinical Practice Guidelines aim to present all the relevant evidence to help physicians weigh the benefits and risks of a particular diagnostic or therapeutic procedure on Cardiovascular Diseases during Pregnancy. There are no data on ABA use in breastfeeding (SOA 100%). S Pulmonary hypertension (PHT) remains a contraindication for pregnancy. Based on very limited evidence, MMF is compatible with paternal exposure (LOE 2−, GOR D, SOA 98.9%). Avoid regular use during weeks 8–14 of pregnancy due to a small reported risk of cryptorchidism (LOE 2+, GOR C, SOA 99.5%). Prednisolone is compatible with paternal exposure (LOE 2+, GOR D, SOA 98.9%). Brucato has received individual support to attend meetings from GlaxoSmithKline, UCB and Astra-Zeneca, chairing fees from Bristol-Myers Squibb and honoraria from GlaxoSmithKline/Human Genome Sciences, Medimmune, INOVA Diagnostics and Merck. Dose increases should be monitored by FBC, creatinine/calculated GFR, ALT and/or AST and albumin every 2 weeks until on stable dose for 6 weeks then revert to previous schedule (GRADE 2B, 97%). e Possible association with miscarriage and malformation. M There are no data relating to breastfeeding or paternal exposure to pulmonary vasodilators on which to base a recommendation (SOA 100%). M.G. Infliximab (IFX) may be continued until 16 weeks and etanercept (ETA) and adalimumab (ADA) may be continued until the end of the second trimester (LOE 2−, GOR D, SOA 98.9%). Lockshin The British Society for Rheumatology (BSR) is the UK's leading specialist medical society for rheumatology and musculoskeletal professionals. A STANDARD 4: Early pregnancy services 16 STANDARD 5: Maternity booking and planning of care 18 STANDARD 6: Pre-existing medical conditions in pregnancy 20 STANDARD 7: Women with social needs 22 STANDARD 8: Pre-existing and developing mental health conditions in pregnancy 24 STANDARD 9: Antenatal … BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: Standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Is it compatible with breastfeeding? A has received unit and individual support to attend meetings from UCB and Jansen UK and participated on an expert panel for UCB. MTX at any dose should be avoided in pregnancy and stopped 3 months in advance of conception (LOE 2−, GOR D, SOA 100%). The prescribing of many drugs in pregnancy is complicated by a lack of knowledge regarding their compatibility, leading to patient misinformation and withdrawal/denial of disease-ameliorating therapies. The prescribing of many drugs in pregnancy is complicated by a lack of knowledge regarding their compatibility leading to patient misinformation and withdrawal/denial of disease-ameliorating therapies. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part II: analgesics and other drugs used in rheumatology practice. Paracetamol is compatible peri-conception and throughout pregnancy [level of evidence (LOE) 2+, grade of recommendation (GOR) C, strength of agreement (SOA) 100%]. Chatbot You can now access all of our COVID-19 guidance through COVA, a button-based chatbot designed to help you find the relevant information you require quickly and easily. . Thank you for submitting a comment on this article. SSZ is compatible with breastfeeding in healthy, full-term infants (LOE 4, GOR D, SOA 100%). . S Therefore, these drugs should be used with caution in the first trimester of pregnancy (LOE 1−, GOR B, SOA 99.5%). Updated 16 December You can find our COVID-19 guidance below. Patients looking for further information on whether their condition places them in a higher-risk category, or about precautions they should take, are advised to speak to their clinical team, who are best placed to answer … AZA is compatible with paternal exposure (LOE 2+, GOR D, SOA 100%). Prednisolone is compatible with breastfeeding (LOE 2−, GOR D, SOA 98.9%). CYC is teratogenic and gonadotoxic, therefore it should only be considered in pregnancy in life-/organ-threatening maternal disease (LOE 2, GOR C, SOA 100%). M.K. SSZ with folate supplementation (5 mg/day) is compatible throughout pregnancy (LOE 2+, GOR C, SOA 100%). There is insufficient evidence to recommend gabapentin for the treatment of chronic pain in pregnancy (LOE 2−, GOR D, SOA 99.5%). There are insufficient data to recommend BEL in pregnancy. A description of evidence and full recommendations are given in the full guideline provided as supplementary data , available at Rheumatology Online. Men taking SSZ may have reduced fertility. M.N. Warfarin is compatible with breastfeeding (LOE 1−, GOR B, SOA 100%). Mothers on tacrolimus should not be discouraged from breastfeeding (LOE 3, GOR D, SOA 99.5%). Cessation of anti-depressant therapy in the post-natal period is not recommended, due to the risk of relapsing depression (LOE 4, GOR D, SOA 99.5%). BSR's 'gold standard' clinical guidelines support evidence-based clinical practice in rheumatology. Unintentional exposure early in the first trimester is unlikely to be harmful (LOE 3, GOR D, SOA 100%). The use of aceis in breastfeeding ( SOA 100 % ), 97 % ), and hence it imp…! Lowest effective dose ( LOE 4, GOR D, SOA 99.5 % ) guidelines independent! At higher risk of toxicity ( GRADE 2B, 97 % ) early the. 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