SAT0136 CONSISTENCY WITH INTERNATIONAL GUIDELINES REGARDING MOTHERS WITH RHEUMATOLOGIC DISEASES EXPOSED TO TUMOUR NECROSIS FACTOR INHIBITORS (TNFI) DURING THE ANTE- AND POSTNATAL PERIODS AND CHANGE OVER TIME

Abstract

Background: Many women with rheumatologic diseases require ongoing treatment with tumour necrosis factor inhibitors (TNFi) during pregnancy to maintain remission or low disease activity. Until recently, therehas been a paucity of published evidence regarding the safety of thesemedications during the ante-and postnatal periods to guide clinical practice.Objectives: To observe compliance with current guidelines for TNFitherapy in Australian women with rheumatologic diseases during theante-and postnatal periods and change over time.Methods: Australian women with rheumatologic diseases, exposed tobiologics (bDMARDs) and targeted synthetic disease modifying antirheumatic drugs (tsDMARDs) during the preconception, antenatal and/orpostpartum periods were eligible to participate in the PregnancyExposed to Biological (PEB) study. Commencing in 2015, recruitmentwas via invitation from patient's treating rheumatologists, communitygroups, and social media. Following self-referral to the study, retrospective data were collected, including rheumatologic condition and recommendations provided to women by health professionals.Results: Preliminary data are available regarding 37 infants born to 29mothers from February 2009 to December 2018. Women exposed tonon-TNFi bDMARDs and tsDMARDs were excluded, as these medications are not currently recommended for use in the perinatal period. Intotal, 32 women received TNFi. We assessed the outcomes of threedomains: TNFi continuation during pregnancy, TNFi continuationduring lactation and vaccination practice in exposed infants. Specialistsociety guidelines were published in January 2016 regarding the safetyof TNFi during pregnancy.1 Of the PEB participants who were pregnantprior to guideline publication, 67% (n = 16/24) ceased TNFi preconception. Of the PEB participants who became pregnant subsequentto guideline publication, only 25% (n = 2/8) ceased TNFi pre-conception.Overall, 40.6% (n = 13/32) women received a TNFi during the antenatalperiod consistent with guidelines, which improved from 33.3% (n = 8/24)pre-publication to 62.5% (n = 5/8) post-publication, and 84.4%(n = 27/32) women in PEB breastfed their infants. Prior to availability ofevidence regarding the safety of TNFi during lactation, 79.2% (n = 19/24)of infants were breastfed. After publication, 100% (n = 32/32) infantsexposed to TNFi were breastfed. In total, 96.9% (n = 31/32) infantsexposed to TNFi in PEB were vaccinated. Rotavirus vaccine shouldhave been delayed in 43.8% (n = 14/32) infants, but was not; 9.4%(n = 3/32) infants had live vaccines delayed until only three months;3.1% (n = 1/32) infants had live vaccines unnecessarily delayed. Only3.1% (n = 1/32) infants had live vaccines appropriately delayed untilseven months. Compliance with vaccination recommendations increasedfrom 43.5% (n = 10/24) pre-publication to 62.5% (n = 5/8) postpublication of guidelines.Conclusion: Preliminary data from PEB suggest that there has been ashift in practice following the publication of specialist society guidelinesand that increasing numbers of women are continuing their TNFi therapyduring pregnancy and the postpartum period in keeping with currentevidence. Compliance with vaccination recommendations could beimproved to be more consistent with published international guidelines.