A SURVEY ON THERAPY WITH IMMUNOSUPPRESSIVE DRUGS AND BIOLOGICAL AGENTS AND USE OF CONTRACEPTION IN PATIENTS WITH RHEUMATIC DISEASE

Background: Drug therapy of rheumatic diseases has changed markedly by the introduction of new immunosuppressive drugs and biological agents. Possible effects of drugs on male and female reproduction are for a majority of substances unknown, leaving both the patient and the physician in uncertainty [1].Objectives: To investigate the use of immunosuppressive drugs in rheumatic patients of fertile age, birth control advised and practiced, and outcome of pregnancies exposed to drugs. The aim was to improve pre-pregnancy counselling of patients with a wish for children.Methods: We performed two postal surveys in regard to immunosuppressive drugs and reproduction, one in patients with rheumatic disease, the second in Swiss Rheumatologists. Questionnaires included demographic and clinical data, treatment with immunosuppressive drugs during the period 2000-2005, advice received for birth control during therapy with immunosuppressive or biological drugs, and contraceptive practice during therapy [2].Results: Among the 237 female patients and the 189 male patients contacted for the survey, 72% of women and 40% of men returned the questionnaire. Ninety-four women and 47 men had received one or several immunosuppressive or biological agents during the years2000-05. Correct advice according to the guidelines given by the Swiss Association of Rheumatologists in regard to drugs and necessary birth control had been given to 84% of women. Related to the paucity of data, advice to men was more inconsistent. One third of women and 50% of men treated with the potentially teratogenic drugs methotrexate or leflunomide had not practiced birth control. The surveys of Rheumatologists and patients disclosed 66 pregnancies under therapy with immunosuppressive and biological drugs with successful outcomes in 73%. However, 20% of pregnancies in women occurred under treatment with methotrexate and leflunomide.Conclusion: Issues regarding drugs and reproduction need to be sufficiently discussed with female and male patients. The introduction of new biologicals and the increasing use of combination therapies containing methotrexate necessitates to ensure that advice regarding birth control is followed in order to avoid pregnancies exposed to potentially fetotoxic drugs.References: 1. Østensen M, Khamashta M, Lockshin M, Parke A, Brucato A, Carp H, et al. Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Res Ther 2006;8:2092. Æstensen M, von Esebeck M, Villiger PM. Therapy with immunosuppressive drugs and biological agents and use of contraception in patients with rheumatic disease. J Rheumatol 2007;34:1266-69.Citation: Ann Rheum Dis, volume 67, supplement II, year 2008, page 412Session: Miscellaneous rheumatic diseases