Methotrexate should be avoided in women trying to conceive or who are pregnant since it is a proven teratogen (pregnancy category X). The data on biologics during pregnancy is much less clear.
The anti-TNF therapies are all pregnancy category B.
The other commonly used biologics in RA (abatacept, rituximab, tocilizumab) are pregnancy category C. The Food and Drug Administration (FDA) currently warns against using biologics in pregnancy.
For women, who require therapy during pregnancy, glucocorticoids, hydroxychloroquine, and occasionally azathioprine (after the first trimester) are the preferred therapies for most physicians who have experience prescribing these agents during pregnancy.
The anti-TNF therapies are all pregnancy category B.
The other commonly used biologics in RA (abatacept, rituximab, tocilizumab) are pregnancy category C. The Food and Drug Administration (FDA) currently warns against using biologics in pregnancy.
For women, who require therapy during pregnancy, glucocorticoids, hydroxychloroquine, and occasionally azathioprine (after the first trimester) are the preferred therapies for most physicians who have experience prescribing these agents during pregnancy.
Methotrexate is to be avoided, in particular, since it is a proven teratogen (pregnancy category X). It should be stopped for at least 1 menstrual cycle and as much as 6 months prior to attempting to conceive.
Men with RA on methotrexate should also discontinue methotrexate for 3 months or more prior to conception.
The data on biologics during pregnancy are much less clear. There have been case series describing various congenital anomalies affecting fetuses of women using these agents, and there have also been anecdotal reports of women experiencing normal pregnancies and good fetal outcomes with exposure to these compounds.
The anti-TNF therapies are all pregnancy category B (animal reproduction studies have failed to demonstrate a risk to the fetus, and there are no adequate and well-controlled studies in pregnant women; or animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester).
The other commonly used biologics for RA (abatacept, rituximab, tocilizumab) are pregnancy category C (animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks).
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