What are the BSR-BHPR guidelines on the use of anti–TNF-alpha agents by pregnant women with rheumatoid arthritis (RA)?

Updated: May 11, 2018
  • Author: Katherine K Temprano, MD; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

BSR-BHPR guidelines include the following recommendations [19] :

  • Infliximab (IFX) may be continued until 16 weeks and etanercept (ETA) and adalimumab (ADA) may be continued until the end of the second trimester 
  • To ensure low/no levels of drug in cord blood at delivery, ETA and ADA should be avoided in the third trimester and IFX stopped at 16 weeks. 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
  • Certolizumab is compatible with all three trimesters of pregnancy and has less placental transfer than other TNF inhibitors (TNFs) 
  • Golimumab is unlikely to be harmful in the first trimester 

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