Table 1.
Approach to disease-modifying therapy for pregnant women with RA (or for women wishing to conceive)
| Preferred medications (if required) | Medications relatively safe to use (require individualized approach) | Contraindicated medications | Inadequate data to support safety |
|---|---|---|---|
| Glucocorticoids (B)a | TNFα inhibitors (B) | Methotrexate (X) | Anakinra (B) |
| NSAIDs (B)b | Azathioprine (D) | Leflunomide (X) | Abatacept (C) |
| Hydroxychloroquine (C) | Tocilizumab (C) | ||
| Sulfasalazine (B) | Tofacitinib (C) | ||
| Rituximab (C)c |
Notes: The US FDA pregnancy category125 for each drug is quoted in parenthesis: A: controlled human studies show no risk; B: no evidence of risk in studies; C: risk cannot be ruled out; D: positive evidence of risk; and X: contraindicated in pregnancy.
a
Counseling advised regarding possible cleft lip/palate abnormalities.
b
Avoid in third trimester due to risk of premature closure of ductus arteriosus.
c
Recommendation is to avoid in pregnancy due to hematologic abnormalities and infection risk.
Abbreviations: RA, rheumatoid arthritis; TNF, tumor necrosis factor; NSAIDs, nonsteroidal anti-inflammatory drugs; FDA, Food and Drug Administration.