There is no evidence to recommend the use of CYC in breastfeeding (LOE 4, GOR D, SOA 100%). There is limited evidence on which to base a recommendation for anakinra in pregnancy, but unintentional exposure in the first trimester is unlikely to be harmful (LOE 2−, GOR D, SOA 96.8%). There are insufficient data on which to base a recommendation regarding paternal exposure to ACEIs, but there are no theoretical concerns (LOE 4, GOR D, SOA 100%). Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review Target audience Health professionals directly involved in managing pa-tients with rheumatic disease in the UK who are (or plan-ning to become) pregnant and/or … Is it compatible with pregnancy? Biologic therapies are not without potential risk, and hence it is imp… IVIG is compatible with pregnancy (LOE 1 ++, GOR A, SOA 100%). Østensen Codeine is compatible peri-conception and throughout pregnancy. Amitriptyline is compatible with pregnancy (LOE 2+, GOR C, SOA 99.5%). et al. A . Hurrell MTX at any dose should be avoided in pregnancy and stopped 3 months in advance of conception (LOE 2−, GOR D, SOA 100%). There are no data on which to base a recommendation for paternal exposure to bisphosphonates (SOA 100%). AZA is compatible with breastfeeding (LOE 2−, GOR D, SOA 99.5%). Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review L.M. Pulmonary hypertension (PHT) remains a contraindication for pregnancy. Unintentional exposure early in the first trimester is unlikely to be harmful (LOE 3, GOR D, SOA 100%). 1693-7. has received individual support to attend a meeting from Roche. Your comment will be reviewed and published at the journal's discretion. Non-selective NSAIDs are compatible with paternal exposure (LOE 2−, GOR D, SOA 98.9%). In the case of accidental pregnancy on low-dose MTX, the drug should be stopped immediately, folate supplementation (5 mg/day) continued and a careful evaluation of foetal risk carried out by local experts (LOE 4, GOR D, SOA 100%). Sammaritano LR(1), Bermas BL(2). These findings are summarized in Table 1 . There are no data on TCZ use in breastfeeding (SOA 99.5%). 2017 Jun 1;56(6):865-868. doi: 10.1093/rheumatology/kew479. Copyright © 2020 British Society for Rheumatology. M.K. Based on limited evidence, RTX is compatible with paternal exposure (LOE 2−, GOR D, SOA 98.4%). Women on LEF considering pregnancy should stop and undergo cholestyramine washout before switching to alternative medication compatible with pregnancy (LOE 2+, GOR C, SOA 100%). For Permissions, please email: journals.permissions@oup.com. Search for other works by this author on: on behalf of the BSR and BHPR Standards, Guidelines and Audit Working Group, State of the art: reproduction and pregnancy in rheumatic diseases, Anti-inflammatory and immunosuppressive drugs and reproduction, Update on safety during pregnancy of biological agents and some immunosuppressive anti-rheumatic drugs, BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding. Caution is advised with the use of codeine in breastfeeding due to the risk of CNS depression resulting from unpredictable metabolism of codeine to morphine (LOE 2+, GOR D, SOA 98.4%). Prednisolone is compatible with breastfeeding (LOE 2−, GOR D, SOA 98.9%). M.G. The use of biologic therapies has transformed the management of inflammatory arthritis (IA). IVIG is compatible with breastfeeding (LOE 4, GOR D, SOA 98.9%). Therefore, if accidental conception occurs on LEF, the drug should be stopped immediately and cholestyramine washout given until plasma levels are undetectable (LOE 2+, GOR C, SOA 98.9%). Based on maternal compatibility, IVIG is unlikely to be harmful (LOE 4, GOR D, SOA 98.9%). Limited evidence supports the use of prostacyclines to treat PHT during pregnancy (LOE 3, GOR D, SOA 99.5%). 2016, 55(9). 2020-11-16T15:54:00Z. "BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids". f No studies identified, but unlikely to be harmful. Disclosure statement : K.S. Venlafaxine is compatible at conception and throughout pregnancy. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. New BSR Guidelines on Biologic Safe Use with Inflammatory Arthritis Save. has received unit and individual support to attend meetings from UCB and Jansen UK and participated on an expert panel for UCB. M HCQ is compatible with breastfeeding (LOE 4, GOR D, SOA 98.9%). Lockshin Andreoli S Østensen Østensen has received individual support to attend meetings from GlaxoSmithKline, UCB and Astra-Zeneca, chairing fees from Bristol-Myers Squibb and honoraria from GlaxoSmithKline/Human Genome Sciences, MedImmune, INOVA Diagnostics and Merck. M Khamashta has undertaken consultancies and received honoraria from Bristol-Myers Squibb, GlaxoSmithKline, MedImmune, Merck Serono and UCB, has been a member of the speakers’ bureau for GlaxoSmithKline, UCB and Lilly and has received research grant support from UCB, but none of these activities have been related to the use of any specific drug in pregnancy. Østensen Author information: (1)Division of Rheumatology, Hospital for Special Surgery, 535 E. 70th Street, New York, New York 10021, USA. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part II: analgesics and other drugs used in rheumatology practice. Prednisolone is compatible with each trimester of pregnancy [level of evidence (LOE) 1 ++, grade of recommendation (GOR) A, strength of agreement (SOA) 100%]. If pregnancy occurs, the use of these pulmonary vasodilator drugs in pregnancy should be considered only as part of a multidisciplinary team assessment (LOE 4, GOR D, SOA 100%). MTX cannot be recommended in breastfeeding because of theoretical risks and insufficient outcome data (LOE 4, GOR D, SOA 100%). Funding : No specific funding was received from any funding bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article. Treatment with MMF should be stopped at least 6 weeks before a planned pregnancy (LOE 3, GOR D, SOR 100%). Tramadol is compatible with pregnancy, although there have been no high-quality studies published investigating the safety of tramadol in pregnancy (LOE 2−, GOR D, SOA 98.4%). Specific questions were considered in relation to each drug. d Suggested monitoring of maternal blood pressure, renal function, blood glucose and drug levels. L.M. et al.  Part 2 of this guideline considers pain manage-BSR and BHPR guideline on prescribing drugs in pregnancy … Flint, Julia et al. This situation should be avoided because active rheumatic disease is associated with adverse pregnancy outcomes [ 1 ] and there is growing evidence of drug safety in pregnancy. Progesterone receptor blockers: historical perspective, mode of function and insights into clinical and scientific applications. Based on limited evidence IFX, ETA and ADA are compatible with paternal exposure (LOE 2−, GOR D, SOA 98.9%). A No data exist on excretion into breast milk, therefore breastfeeding is not recommended (LOE 4, GOR D, SOA 100%). For further information and caveats, see the relevant recommendations and main text in the executive summary and full guideline. supplementary data Based on limited evidence, LEF may not be a human teratogen but it is still not recommended in women planning pregnancy (LOE 2+, GOR C, SOA 100%). BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding Description: British Society for Rheumatology (BSA) and British Health Professionals in Rheumatology (BHPR) guideline on prescribing drugs in pregnancy and breastfeeding – Part 1: Standard and biologic disease modifying anti-rheumatic drugs and corticosteroids Objectives of the guideline… M at Rheumatology Online. This advice is for clinicians. Based on limited data, tramadol may be compatible with short-term use in breastfeeding (LOE 2−, GOR D, SOA 97.9%). guideline, part 1, considers antimalarials, corticosteroids, DMARDs and immunosuppressive therapies and bio-logics. 2016 NICE-accredited. Should it be stopped pre-conception? Limited evidence has not shown RTX to be teratogenic and only second-/third-trimester exposure is associated with neonatal B cell depletion. There is no evidence, however, that conception is enhanced by stopping SSZ for 3 months prior to conception unless conception is delayed >12 months when other causes of infertility should also be considered (LOE 3, GOR D, SOA 97.4%). There are insufficient data to recommend BEL in pregnancy. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part II: analgesics and other drugs used in rheumatology practice Read time: 1 mins Last updated: 2nd Mar 2016 The British Society of Rheumatology (BSR) has released guidelines … At present, there are limited data on selective COX-2 inhibitors; they should therefore be avoided during pregnancy (LOE 2+, GOR D, SOA 98.9%). There are no data relating to paternal exposure to selective serotonin reuptake inhibitors, but based on maternal compatibility, they are unlikely to be harmful (LOE 4, GOR D, SOA 98.4%). The BSR issued guidelines for the treatment of adult psoriatic arthritis with biologic agents (particularly anti-TNF therapy). has received educational support from Daiichi Sankyo. Read the Guidelines summary of the BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding for more information on the correct prescribing of anti-rheumatic drugs References de Man Y, Dolhain R, Geijn F et al. Is it compatible with pregnancy? Khamashta LDA may be continued throughout pregnancy and National Institute for Health and Care Excellence guidelines (August 2010) for hypertension in pregnancy advise treatment with LDA (for prophylaxis of pre-eclampsia) until delivery (LOE 1+, GOR B, SOA 100%). There are no data relating to breastfeeding or paternal exposure to pulmonary vasodilators on which to base a recommendation (SOA 100%). To provide evidence-based recommendations, which do not imply a legal obligation, for clinicians to follow when prescribing drugs commonly used in the management of multisystem rheumatic conditions before/during pregnancy and breastfeeding, updating previous recommendations [ 2 , 3 ]. . has received individual support to attend a meeting from Roche. Published by Oxford University Press on behalf of the British Society for Rheumatology. There are no data on paternal exposure to paracetamol, but due to maternal compatibility, it is unlikely to be harmful (LOE 4, GOR D, SOA 99.5%). There are no data on which to base a recommendation for the use of bisphosphonates during breastfeeding (SOA 99.5%). b No studies identified, but unlikely to be harmful due to maternal compatibility. There is limited evidence on the use of ACEIs in breastfeeding. An accompanying description of evidence and full recommendations are given in the full guideline, available as J I.G. Summary of drug compatibility in pregnancy and breastfeeding. Flint 2016-01-18T00:00:00. There is no human evidence of increased congenital abnormalities on LEF if washout is given. A Lockshin M.G. Limited evidence supports the use of sildenafil to treat PHT during pregnancy (LOE 3, GOR D, SOA 99.5%). M M.N. Guideline on prescribing drugs in pregnancy and breastfeeding Part 1: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. These findings are summarized in Table 1 . Should it be stopped pre-conception? A description of evidence and full recommendations are given in the full guideline provided as supplementary data , available at Rheumatology Online. There is no consensus on best practices for drug management during pregnancy by rheumatologists. M (2)Division of Rheumatology, Brigham and Women's Hospital, 75 Frances Street, … 2016 Sep;55(9):1693-7. doi: 10.1093/rheumatology/kev404. BSR's 'gold standard' clinical guidelines support evidence-based clinical practice in rheumatology. . Your comment will be reviewed and published at the journal's discretion. Tacrolimus is compatible throughout pregnancy at the lowest effective dose (LOE 2−, GOR D, SOA 99.5%). Target audience Health professionals directly involved in managing patients with rheumatic disease in the UK who are or are planning to become pregnant and/or breastfeeding, men … Treatment paradigms for managing pregnancy in rheumatoid arthritis (RA) have been challenged in recent years with the introduction of new agents and reclassification of drug safety during pregnancy by the FDA. Objective: To develop an evidence-based guideline on contraception, assisted reproductive technologies (ART), fertility preservation with gonadotoxic therapy, use of menopausal hormone replacement therapy (HRT), pregnancy assessment and management, and medication use in patients with rheumatic and musculoskeletal … Therefore, unintentional RTX exposure early in the first trimester is unlikely to be harmful (LOE 2−, GOR D, SOA 97.9%). Inhibitor ; COX: cyclooxygenase ; LMWH: low molecular weight heparin MDT. 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