Comments on the EULAR recommendations on the use of antirheumatic drugs in reproduction, pregnancy, and lactation
E. A. Trofimov,
V. I. Mazurov,
A. M. Lila,
A. I. Griva,
I. S. Svintsitskaya,
V. A. Likhodkin,
A. S. Trofimova https://doi.org/10.14412/1996-7012-2025-6-25-34
Abstract
Since the publication in 2016 of the EULAR statements on the use of antirheumatic drugs before conception, during pregnancy, and breastfeeding, results of several studies on the safety of these drugs in these periods have appeared, allowing a substantial update of the previous version. New data make it possible to increase the level of evidence for some medications. All recommendations are supported by expert consensus with a high degree of agreement. The updated version includes recommendations on the use of antirheumatic drugs in women and men planning conception, as well as during pregnancy and lactation.
Keywords
EULAR recommendations,
rheumatic diseases,
antirheumatic drugs,
reproductive health,
pregnancy,
lactation period
Supporting agencies: The investigation has not been sponsored
About the Authors
E. A. Trofimov
North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russia
Russian Federation
Russian Federation
41, Kirochnaya Street, Saint Petersburg 191015
V. I. Mazurov
North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russia
Russian Federation
Russian Federation
41, Kirochnaya Street, Saint Petersburg 191015
A. M. Lila
V.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
Russian Federation
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522; 2/1, Barrikadnaya Street, Build. 1, Moscow 125993
A. I. Griva
North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russia
Russian Federation
Russian Federation
Arina Igorevna Griva
41, Kirochnaya Street, Saint Petersburg 191015
I. S. Svintsitskaya
S.M. Kirov Military Medical Academy, Ministry of Defense of Russia
Russian Federation
Russian Federation
6Zh, Akademika Lebedeva Street, Saint Petersburg 194044
V. A. Likhodkin
S.M. Kirov Military Medical Academy, Ministry of Defense of Russia
Russian Federation
Russian Federation
6Zh, Akademika Lebedeva Street, Saint Petersburg 194044
A. S. Trofimova
North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russia
Russian Federation
Russian Federation
41, Kirochnaya Street, Saint Petersburg 191015
References
1. Götestam Skorpen C, Hoeltzenbein M, Tincani A, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016 May;75(5):795810. doi: 10.1136/annrheumdis-2015-208840.
2. Rüegg L, Pluma A, Hamroun S, et al. EULAR recommendations for use of antirheumatic drugs in reproduction, pregnancy, and lactation: 2024 update. Ann Rheum Dis. 2025 Jun;84(6):910-926. doi: 10.1016/j.ard.2025.02.023.
3. Pluma A, Hamroun S, Rüegg L, et al. Antirheumatic drugs in reproduction, pregnancy, and lactation: a systematic literature review informing the 2024 update of the EULAR recommendations. Ann Rheum Dis. 2025 Sep;84(9):1561-1590. doi: 10.1016/j.ard.2025.02.021.
4. Singh M, Wambua S, Lee SI, et al; MuM-PreDiCT. Autoimmune diseases and adverse pregnancy outcomes: an umbrella review. BMC Med. 2024 Mar 5;22(1):94. doi: 10.1186/s12916-024-03309-y.
5. Bosshard N, Zbinden A, Eriksson KK, Förger F. Rituximab and Canakinumab Use During Lactation: No Detectable Serum Levels in Breastfed Infants. Rheumatol Ther. 2021 Jun;8(2):1043-1048. doi: 10.1007/s40744-021-00313-z. Epub 2021 May 17.
6. Russell MD, Dey M, Flint J, et al; BSR Standards, Audit and Guidelines Working Group. British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory antirheumatic drugs and corticosteroids. Rheumatology (Oxford). 2023 Apr 3;62(4):e48-e88. doi: 10.1093/rheumatology/keac551.
7. Chambers CD, Johnson DL, Xu R, et al; OTIS Collaborative Research Group. Birth Outcomes in Women Who Have Taken Hydroxycholoroquine During Pregnancy: A Prospective Cohort Study. Arthritis Rheumatol. 2022 Apr;74(4):711-724. doi: 10.1002/art.42015.
8. Nørgеrd BM, Friedman S, Kjeldsen J, Nielsen J. The safety of paternal and maternal use of 5-aminosalicylic acid during conception and pregnancy: a nationwide cohort study. Aliment Pharmacol Ther. 2022 Nov; 56(9):1349-1360. doi: 10.1111/apt.17189.
9. Torres J, Chaparro M, Julsgaard M, et al. European Crohn's and Colitis Guidelines on Sexuality, Fertility, Pregnancy, and Lactation. J Crohns Colitis. 2023 Jan 27;17(1):1-27. doi: 10.1093/ecco-jcc/jjac115.
10. Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol. 2020 Apr;72(4):529-556. doi: 10.1002/art.41191.
11. Dathe K, Frank J, Padberg S, et al. Fetal adverse effects following NSAID or metamizole exposure in the 2nd and 3rd trimester: an evaluation of the German Embryotox cohort. BMC Pregnancy Childbirth. 2022 Aug 26;22(1): 666. doi: 10.1186/s12884-022-04986-4.
12. Choi EY, Jeong HE, Noh Y, et al. Neonatal and maternal adverse outcomes and exposure to nonsteroidal anti-inflammatory drugs during early pregnancy in South Korea: A nationwide cohort study. PLoS Med. 2023 Feb 27;20(2):e1004183. doi: 10.1371/journal.pmed.1004183.
13. Trofimov EA, Mazurov VI, Gaidukova IZ. The use of tumor necrosis factor inhibitors in patients with rheumatoid arthritis during pregnancy: own observations. Terapiya. 2019;(8):59-66. (In Russ.).
14. Orozco-Guillen AO, Abraham VS, Moguel Gonzalez B, et al. Kidney-Limited Full-House Lupus-like Membranous Nephropathy and Membranoproliferative Glomerulonephritis in Pregnancy. Kidney Int Rep. 2023 Jan 16;8(4):932-938. doi: 10.1016/j.ekir.2023.01.006.
15. Rüegg L, Hamroun S, Sanjurjo A, et al. POS0886 No increased risks of serious infections in infants after in-utero exposure to tnf inhibitors: a systematic review and metaanalysis informing the EULAR task force on antirheumatic drugs in reproduction, pregnancy and lactation. Ann Rheum Dis. 2024; 83:1144-1145. doi: 10.1136/annrheumdis2024-eular.2677.
16. Perez-Garcia LF, Dolhain RJEM, Vorstenbosch S, et al. The effect of paternal exposure to immunosuppressive drugs on sexual function, reproductive hormones, fertility, pregnancy and offspring outcomes: a systematic review. Hum Reprod Update. 2020 Nov 1; 26(6):961-1001. doi: 10.1093/humupd/ dmaa022.
17. Andersen JB, Wandall-Holm MF, Magyari M. Pregnancy outcomes following maternal or paternal exposure to teriflunomide in the Danish MS population. Mult Scler Relat Disord. 2022 Mar;59:103529. doi: 10.1016/j.msard.2022.103529.
18. Perez-Garcia LF, Röder E, Krijthe BP, et al. Is methotrexate safe for men with an immune-mediated inflammatory disease and an active desire to become a father? Results of a prospective cohort study (iFAME-MTX). Ann Rheum Dis. 2023 Aug;82(8):1068-1075. doi: 10.1136/ard-2023-224032.
Review
For citations:
Trofimov EA, Mazurov VI, Lila AM, Griva AI, Svintsitskaya IS, Likhodkin VA, Trofimova AS. Comments on the EULAR recommendations on the use of antirheumatic drugs in reproduction, pregnancy, and lactation. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2025;19(6):25-34. (In Russ.) https://doi.org/10.14412/1996-7012-2025-6-25-34
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