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Use of disease-modifying antirheumatic drugs during pregnancy and risk of preeclampsia.

ABSTRACT: To describe patterns of disease-modifying antirheumatic drug (DMARD) use during pregnancy in a population-based cohort, and to evaluate the association between autoimmune disease, DMARDs, corticosteroids, and nonsteroidal antiinflammatory drugs (NSAIDs) and preeclampsia.Using health care utilization databases from British Columbia (1997-2006), we compared the risk for preeclampsia among 44,786 women with and without autoimmune disease with study drug dispensings before pregnancy (past users) and before and during the first 20 gestational weeks (continuous users). Relative risks (RRs) and 95% confidence intervals (95% CIs) were estimated.Only 414 women (0.1%) had a DMARD dispensing during pregnancy. The incidence of preeclampsia was 2.3% for past DMARD users, 2.7% for past corticosteroid users, and 2.9% for past NSAID users. Compared to past users, the continuous DMARD user RR was 2.29 (95% CI 0.81-6.44), and was 0.89 (95% CI 0.51-1.56) for corticosteroid and 0.84 (95% CI 0.63-1.10) for NSAID users. Compared to women without autoimmune disease, the delivery year-adjusted RR was 2.02 (95% CI 1.11-3.64) for women with systemic lupus erythematosus (SLE). The DMARD results were attenuated when antimalarials were excluded, and the delivery year-adjusted RR was 0.95 (95% CI 0.25-3.55) when the DMARD analysis was restricted to women with autoimmune disease.Few women were exposed to DMARDs during pregnancy. We observed a 2-fold increased risk of preeclampsia among women with SLE and a nonsignificant increase in risk in DMARD users. The DMARD and preeclampsia association was attenuated when antimalarials were excluded and null when restricted to women with autoimmune disease, which suggests the association is likely due to greater autoimmune disease severity in DMARD users.

SUBMITTER: Palmsten K

PROVIDER: S-EPMC3514881 | biostudies-literature | 2012 Nov

REPOSITORIES: biostudies-literature

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Use of disease-modifying antirheumatic drugs during pregnancy and risk of preeclampsia.

Palmsten Kristin K Hernández-Díaz Sonia S Kuriya Bindee B Solomon Daniel H DH Setoguchi Soko S

Arthritis care & research 20121101 11

<h4>Objective</h4>To describe patterns of disease-modifying antirheumatic drug (DMARD) use during pregnancy in a population-based cohort, and to evaluate the association between autoimmune disease, DMARDs, corticosteroids, and nonsteroidal antiinflammatory drugs (NSAIDs) and preeclampsia.<h4>Methods</h4>Using health care utilization databases from British Columbia (1997-2006), we compared the risk for preeclampsia among 44,786 women with and without autoimmune disease with study drug dispensings ...[more]

PMID: 23111855

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Project description:Recent research suggests that rheumatoid arthritis increases the risk of venous thromboembolism. This study compared the risk of venous thromboembolism in patients with newly diagnosed rheumatoid arthritis initiating a biologic disease-modifying antirheumatic drug (DMARD) with those initiating methotrexate or a nonbiologic DMARD.We conducted a population-based cohort study using US insurance claims data (2001-2012). Three mutually exclusive, hierarchical DMARD groups were used: (1) a biologic DMARD with and without nonbiologic DMARDs; (2) methotrexate without a biologic DMARD; or (3) nonbiologic DMARDs without a biologic DMARD or methotrexate. We calculated the incidence rates of venous thromboembolism. Cox proportional hazard models stratified by propensity score (PS) deciles after asymmetric PS trimming were used for 3 pairwise comparisons, controlling for potential confounders at baseline.We identified 29,481 patients with rheumatoid arthritis with 39,647 treatment episodes. From the pairwise comparison after asymmetric PS trimming, the incidence rate of hospitalization for venous thromboembolism per 1000 person-years was 5.5 in biologic DMARD initiators versus 4.4 in nonbiologic DMARD initiators and 4.8 in biologic DMARD initiators versus 3.5 in methotrexate initiators. The PS decile-stratified hazard ratio of venous thromboembolism associated with biologic DMARDs was 1.83 (95% confidence interval [CI], 0.91-3.66) versus nonbiologic DMARDs and 1.39 (95% CI, 0.73-2.63) versus methotrexate. The hazard ratio of venous thromboembolism in biologic DMARD initiators was the highest in the first 180 days versus nonbiologic DMARD initiators (2.48; 95% CI, 1.14-5.39) or methotrexate initiators (1.80; 95% CI, 0.90-3.62).The absolute risk for venous thromboembolism was low in patients with newly diagnosed rheumatoid arthritis. Initiation of a biologic DMARD seems to be associated with an increased short-term risk of hospitalization for venous thromboembolism compared with initiation of a nonbiologic DMARD or methotrexate.

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Use of disease-modifying antirheumatic drugs during pregnancy and risk of preeclampsia.

Publications

Use of disease-modifying antirheumatic drugs during pregnancy and risk of preeclampsia.

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