5 years ago

Patterns of biologics utilization and discontinuation before and during pregnancy in women with autoimmune diseases: A population-based cohort study

Mohsen Sadatsafavi, Larry D. Lynd, Gillian Hanley, Mary A. De Vera, Nicole W. Tsao
Objectives To characterize the patterns of biologics utilization and discontinuation before and during pregnancy in women with autoimmune diseases in British Columbia, Canada. Methods Women with one or more autoimmune diseases identified by International Classification of Diseases 9th/10th revision codes that had pregnancies ending in deliveries between January 1st, 2002 and December 31st, 2012; and had at least one prescription for a biologic one year before, or during, pregnancy were included. We examined secular trends, patterns of biologics use, and risk of biologics discontinuation before and during pregnancy. Associations between drug discontinuations and various factors were investigated using multilevel logistic regression models, fitted with binomial generalized estimating equations. Results Of 6,218 women (8,431 pregnancies) with autoimmune diseases, 131 women (144 pregnancies) were exposed to a biologic before or during pregnancy. Use of biologics in this cohort increased from 0% in 2002 to 5.7% by 2012 (p<0.001). Within the first trimester of pregnancy, 31% (34/110) of women discontinued their biologic and 38% (30/79) discontinued in the second trimester, while 98% (50/51) of those who were on treatment in the second trimester remained on treatment in the third trimester. Women with rheumatoid arthritis had three times higher odds (OR 3.40 [95%CI 1.33-8.71]) of discontinuing biologics during pregnancy, compared to those with inflammatory bowel disease. Conclusions Given the increased utilization of biologics and high odds of discontinuation during pregnancy in certain populations, more research is needed to improve our understanding of the risks and benefits of biologics on fetal and maternal health. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/acr.23434

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