SAT0129 DISEASE FLARES DURING PREGNANCY IN RHEUMATOID ARTHRITIS: WHAT IS THE IMPACT OF STOPPING BDMARDS AT THE BEGINNING OF PREGNANCY?

Background:

During pregnancy, patients with rheumatoid arthritis (RA) can experience flares, which might influence pregnancy ouctomes.

Objectives:

To assess disease course during pregnancy and identify possible risk factors of disease flares in RA.

Methods:

Data on RA patients prospectively-followed in a pregnancy clinic were retrospectively analyzed before conception and during each trimester. Clinical characteristics, disease activity (DAS28-CRP3), medication use, and pregnancy outcomes were analyzed. Flare was defined by an increase of DAS28-CRP3 greater than 0.6.

Results:

Among 85 RA-pregnancies (mean age 34, SD 4,8; median disease duration 97 months, IQR 31-156) in 66 patients enrolled between 2010 and 2018, 8 pregnancies ended with early miscarriages, 1 with intrauterine fetal death and 2 were voluntary interrupted (1 for MTX exposure and 1 for encephalocele). The remaining seventy-four pregnancies in 62 patients were analyzed. Before conception, 52(71%) were in remission, 13(18%) in low disease activity and 8(11%) with moderate disease activity. Flares occurred in 29/74 (39%) patients during pregnancy (14/1° trimester,18 2° trimester,9 3° trimester). Flares occured more frequently in patients with a previous use of more than one conventional DMARDs (cDMARDs)(p 0,28) and a higher disease activity before conception (0,025) and in the 1°trimester (p 0,08). At conception, 30 (41%) patients were on biological DMARDs (bDMARDs) (16 ETA, 8 CTZ, 3 GOL, 2 ADA) and 16% with an active disease. 29 discontinued the treatment at positive pregnancy test and 8(27%) reintroduced bDMARDs because a flare during 1° (1 CTZ, 1 ETA), 2°(1 ADA, 2CTZ, 2 ETA) and 3° trimester (1 ETA) (Figure 1). 20/30(66%) experienced at least one flare during pregnancy.Forty-four (59%) patients were bDMARDs naive at conception (47% CCS, 41% HCQ, 16% SSZ, 2,3% MTX, 4,5% CyA), 6(7%) with an active disease. 16/44(36%) patients experienced at least one flare during pregnancy, 3 more than one flare (Figure 1). Seventeen live births were accompanied by complications (7 preterm deliveries, 2 very preterm deliveries, 6 premature rupture of membranes and 2 newborns small for gestational age). 60% of preterm births occurred in patients with a flare during pregnancy.

Conclusion:

In a cohort of prospectively-followed RA-pregnancies 39% of patients experienced at least one flare during pregnancy. A higher frequency was observed in patients on bDMARDs at conception after stopping the drug at positive pregnancy test. This suggests that patients with a more aggressive disease, as those on bDMARDs, require continuing treatment beyond conception. Counselling of patients on preconception treat-to-target management may help to achieve lower disease activity, especially in patients with a more severe disease (active disease or previous use of more than one cDMARDs). This may result in better pregnancy outcomes.

Acknowledgement:

None

Disclosure of Interests:

Maria Chiara Gerardi: None declared, Antía García Fernández: None declared, Laura Andreoli: None declared, Francesca Crisafulli: None declared, Matteo Filippini: None declared, Micaela Fredi: None declared, Roberto Gorla: None declared, Maria Grazia Lazzaroni: None declared, Cecilia Nalli: None declared, Marco Taglietti: None declared, Andrea Lojacono: None declared, Sonia Zatti: None declared, Angela Tincani Consultant for: UCB, Pfizer, Abbvie, BMS, Sanofi, Roche, GSK, AlphaSigma, Lillly, Jannsen, Cellgene, Novartis