1. Anti-rheumatic Drugs In Pregnancy And Breastfeeding
Prof. Munther A Khamashta MD FRCP PhD Director: Graham Hughes Lupus Research Laboratory
The Rayne Institute, St Thomas Hospital
( Dubai Hospital Rheumatology Department )
Challenges in Obstetrics & Gynaecology, Kuwait, February 2017

2. Antirheumatic drugs & pregnancy
Considerations
Lack of comparative clinical trials
Experimental findings in animals cannot be extrapolated to humans
Most drugs cross the placenta easily
Greatest risk: first trimester for most drugs
Delayed effect of drugs following intrauterine exposure
Abnormal results are more likely to be published

3. Antirheumatic drugs & pregnancy
Short-term and long-term effects of maternal use of drugs are a matter of considerable concern for both patients and physicians

4. Antirheumatic drugs & pregnancy
Therapeutic principle
An active systemic rheumatic disease with major organ involvement may pose a greater threat to the mother, and indirectly to her fetus, than the drug therapy she requires to control her disorder

5. The workshop on antirheumatic drugs in pregnancy
A consensus workshop of 29 specialists was held at the 4th International Conference on Sex Hormones, Pregnancy and Rheumatic Diseases, Sept 2004, Stresa, Italy

6. PrEscribing in Rheumatic Disease In Pregnancy And Lactation (PERDIPAL)
Rheumatology 12 Jan 2016
Points to consider for use of Antirheumatic Drugs before pregnancy and during pregnancy and lactation
Ann Rheum Dis 17 feb 2016

9. Drugs during pregnancy
Compatible
Paracetamol
Low-dose Aspirin
Sulphasalazine
NSAIDs (until week 32)
Hydroxychloroquine
Prednisone/Prednisolone
Azathioprine
Cyclosporin
Tacrolimus
Colchicine
IVIg
Anti-TNF
Not compatible
Cyclophosphamide
Methotrexate
Mycophenolate
Leflunomide
Mepacrine
Selective COXII inhib
Rituximab
Belimumab
Tofacitinib
Abatacept

11. Structure of the TNF-Blocking Agents
p75 Soluble TNF Receptor
Fab′
Fab
PEG
IgG1 Fc
Recombinant Receptor/ Fc Fusion Protein
Monoclonal Antibody
PEGylated Fab′ Anti-TNF
Infliximab
Adalimumab
Golimumab
Certolizumab pegol
Etanercept
Certolizumab pegol is structurally different: It is PEGylated, univalent, and does not have an Fc
All 4 reagents are bivalent and have an active isotype Fc

13. EULAR task force Ann Rheum Dis 2016

18. ARE COMPATIBLE CYCLOPHOSPHAMIDE, MYCOPHENOLATE, METHOTREXATE,
ASPIRIN, WARFARIN,
HEPARIN, PREDNISONE,
HYDROXYCHLOROQUINE,
AZATHIOPRINE, CYCLOSPORIN,
TACROLIMUS, COLCHICINE,
IVIG, SULFASALAZINE
Anti -TNF
ARE COMPATIBLE
CYCLOPHOSPHAMIDE,
MYCOPHENOLATE,
METHOTREXATE,
LEFLUNOMIDE
CAN HARM ME

19. Obstetrics, Gynaecology & Reproductive Medicine 2013;23:137–145

20. Lupus Unit London Rheumatology Dept Dubai