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SpA Pregnancy Biologic Choice — SCE Rheumatology MCQ

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HardSpondyloarthropathySpA Pregnancy Biologic ChoiceSCE Rheumatology

A 30-year-old woman with AS has achieved sustained ASDAS inactive disease on Adalimumab for 2 years. She plans to start a family. According to BSR 2016 prescribing in pregnancy guidelines what is the recommended approach?

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Correct answer: C — Consider switching to Certolizumab pegol before conception due to its minimal placental transfer or continue Adalimumab with a plan to stop in the third trimester

For women with SpA planning pregnancy BSR 2016 prescribing guidelines and EULAR 2024 recommendations favour Certolizumab pegol as the anti-TNF of choice due to its negligible placental transfer (no Fc portion). If already on Adalimumab the options are: switch to Certolizumab pre-conception or continue Adalimumab with discontinuation in the third trimester (to minimise neonatal immunosuppression from transplacental IgG transfer). Adalimumab crosses the placenta increasingly from second trimester via FcRn. If continued neonates should avoid live vaccines for at least 6 months after birth. NSAIDs can be used until week 28-32.

Reference: BSR 2016 prescribing in pregnancy; EULAR 2024 antirheumatic drugs in reproduction