Patterns of Use and Discontinuation for Tumor Necrosis Factor Inhibitors in Pregnant Women: Insights From a Real-World Sample

Abstract

Objective: We aimed to evaluate tumor necrosis factor inhibitor (TNFi) usage patterns in pregnant women with rheumatoid arthritis (RA), radiographic axial spondyloarthritis (r-axSpA), psoriatic arthritis (PsA), psoriasis (PsO), and inflammatory bowel diseases (IBD), and to compare corticosteroid use in those discontinuing TNFi at specific gestational timepoints vs those continuing throughout gestation.

Methods: We analyzed pregnancies resulting in a live birth among women with RA, r-axSpA, PsA, PsO, and/or IBD, aged 15-45 years, who were hospitalized for delivery between January 2011 and December 2021, using the MarketScan commercial claims database. TNFi exposure was defined as ≥ 1 filled prescription or infusion procedure claim for a TNFi. Timing of exposure was categorized by the gestational period and specific trimesters, with a grace period of 5 half-lives added to each prescription to account for ongoing biological activity.

Results: We identified 3711 pregnancies exposed to TNFi among 49,925 women with RA, r-axSpA, PsA, PsO, and/or IBD. Of the 3711 pregnancies, 64% had continuous TNFi use throughout all 3 trimesters. Most (89%) of TNFi-exposed pregnancies had preconception exposure, and 68% of the women continued TNFi postpartum. The proportion of pregnancies with TNFi use throughout all trimesters increased from 55% in 2011-2013 to 73% in 2020-2021 (P for trend < 0.001). Corticosteroid use during pregnancy/postpartum was less frequent in pregnancies exposed to TNFi throughout gestation vs those exposed in the first and/or second trimester only.

Conclusion: We observed trends toward increased continuous TNFi use throughout gestation (and fewer corticosteroids in this group), suggesting growing confidence in the safety and effectiveness of TNFi use in pregnancy.

Keywords: autoimmune diseases; pregnancy; tumor necrosis factor inhibitor.