EULAR 2019: Safety of antiTNFs during pregnancy

In RA the story is similar, but as Dr. Nelson-Pierce said, the idea that pregnancy improves RA is not only old school but also completely false. Half of the patients with RA will flare during pregnancy and this is associated with negative pregnancy outcomes. Management dilemmas are still a big issue in this topic. During her presentation, Dr. Nelson-Piercey used most of her time talking about the safety of antiTNFs during pregnancy. In summary: They cross the placenta and levels in babies are higher than in mothers. It usually takes them 6 months to clear them out and this is why live vaccines should be avoided until then (BCG and rotavirus). Because of the different molecular structure of certizumal pegol and its inability to cross the plscenta, this might be the safest drug to use if needed during the whole pregnancy. Another key message was that while usually talks about teratogenic drugs focus on methotrexate, mycophenolate mofetil might be more dangerous since it has a bigger probability of congenital malformations. Every woman on mycophenolate should have the opportunity to discuss this issue and talk about the contraception. Last but not least, the risk of infections seems to…