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Background: Disease activity (DA) at conception is one of the main predictors of pregnancy outcomes in women of childbearing age (WoCBA) with rheumatic diseases. Teratogenicity and unawareness about pregnancy compatibility of some disease-modifying anti-rheumatic drugs might limit the choice of treatment in WoCBA.
Objectives: To assess differences in prescription patterns between WoCBA with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and juvenile idiopathic arthritis (JIA) and comparator groups, namely postmenopausal women (PMW) and age-matched men. Evaluate DA in WoCBA comparing to the aforementioned groups.
Methods: Observational transversal study, using data from the portuguese registry of rheumatic diseases (Reuma.pt) from 3 portuguese centers. Adult patients (pts) with the diagnosis of RA, PsA, AS or JIA were allocated to the following groups: WoCBA (aged 18–44y), young men (YM) (18–44y), PMW (≥ 45y) and matched men (≥45y). Demographic and clinical variables are described as means or frequencies. Differences between groups regarding therapy and DA were assessed with Chi-square and ANOVA tests. Linear and logistic regression models were used to find predictors of DA and prescription patterns.
Results: 2133 pts were included, 69.9% female with a mean age of 55.96±15.85 y. 1437 pts were diagnosed with RA, 305 with PsA, 254 with AS and 137 with JIA. Patterns of prescription are detailed in
Prescription patterns
| Medications, n (%) | A -WoCBA
| B - Young Men
| C - Post menopausal Women
| D - Men
| Chi-square test |
|---|---|---|---|---|---|
| NSAIDs | 143 (55.9) | 111(68.9) | 472 (50.9) | 169 (49.7) | p<0.001 |
| Glucocorticoids | 106 (41.4) | 31 (19.3) | 625 (67.4) | 154 (45.3) | p<0.001 |
| csDMARDs | |||||
| - Methotrexate | 149 (58.2) | 60 (37.3) | 663 (71.5) | 197 (57.9) | p<0.001 |
| - Leflunomide | 12 (4.7) | 4 (2.5) | 45 (4.9) | 2 (0.6) | p=0.003 |
| - Sulfassalazine | 9 (3.5) | 5 (3.1) | 39 (4.2) | 9 (2.7) | NS |
| - Hydroxychloroquine | 36 (14.1) | 4 (2.5) | 117 (12.6) | 18 (5.3) | p<0.001 |
| bDMARDs | |||||
| - Etanercept | 48 (18.8) | 29 (18.0) | 140 (15.1) | 66 (19.4) | NS |
| - Infliximab | 9 (3.5) | 11 (6.8) | 36 (3.9) | 30 (8.8) | p=0.002 |
| - Adalimumab | 17 (6.6) | 15 (9.3) | 47 (5.1) | 27 (7.9) | NS |
| - Golimumab | 15 (5.9) | 18 (11.2) | 37 (4.0) | 30 (8.8) | p<0.001 |
| - Certolizumab | 10 (3.9) | 0 (0) | 2 (0.3) | 2 (0.6) | p<0.001 |
| - Tocilizumab | 12 (4.7) | 2 (1.2) | 71 (7.7) | 10 (2.9) | p<0.001 |
| - Rituximab | 5 (1.9) | 0 (0) | 50 (5.4) | 4 (1.2) | p<0.001 |
| - Abatacept | 0 (0) | 0 (0) | 9 (1) | 0 (0) | NS |
| - Secukinumab | 1 (0.4) | 4 (3.5) | 8 (0.9) | 2 (0.6) | NS |
| - Ustekinumab | 1 (0.4) | 3 (1.9) | 5 (0.5) | 0 (0) | NS |
| tsDMARDs | 4 (1.6) | 1 (0.6) | 9 (0.9) | 0 (0) | NS |
bDMARDs – biologic disease modifying antirheumatic drugs, csDMARDs – conventional synthetic disease modifying antirheumatic drugs, NSAIDs – non-steroidal anti-inflammatory drugs, tsDMARD – targeted synthetic disease modifying antirheumatic drugs, WoCBA – women of childbearing age
Conclusion: Certolizumab was prescribed preferentially in WoCBA, who alsoreceived more MTX than YM. Nevertheless, DA in this group was not well controlled, which may influence future pregnancy outcomes. Ensuring tight DA control in WoCBA through proper and ideally no teratogenic medication remains an unmet clinical need.
Disclosure of Interests: None declared