Patterns of Use and Discontinuation for Tumor Necrosis Factor Inhibitors in Pregnant Women: Insights From a Real-World Sample

Objective We aimed to evaluate tumor necrosis factor inhibitor (TNFi) usage patterns in pregnant women with rheumatoid arthritis (RA), radiographic axial spondyloarthritis (r-axSpA), psoriatic arthritis (PsA), psoriasis (PsO), and inflammatory bowel diseases (IBD), and to compare corticosteroid use in those discontinuing TNFi at specific gestational timepoints vs those continuing throughout gestation. Methods We analyzed pregnancies resulting in a live birth among women with RA, r-axSpA, PsA, PsO, and/or IBD, aged 15-45 years, who were hospitalized for delivery between January 2011 and December 2021, using the MarketScan commercial claims database. TNFi exposure was defined as ≥ 1 filled prescription or infusion procedure claim for a TNFi. Timing of exposure was categorized by the gestational period and specific trimesters, with a grace period of 5 half-lives added to each prescription to account for ongoing biological activity. Results We identified 3711 pregnancies exposed to TNFi among 49,925 women with RA, r-axSpA, PsA, PsO, and/or IBD. Of the 3711 pregnancies, 64% had continuous TNFi use throughout all 3 trimesters. Most (89%) of TNFi-exposed pregnancies had preconception exposure, and 68% of the women continued TNFi postpartum. The proportion of pregnancies with TNFi use throughout all trimesters increased from 55% in 2011-2013 to 73% in 2020-2021 ( P for trend < 0.001). Corticosteroid use during pregnancy/postpartum was less frequent in pregnancies exposed to TNFi throughout gestation vs those exposed in the first and/or second trimester only. Conclusion We observed trends toward increased continuous TNFi use throughout gestation (and fewer corticosteroids in this group), suggesting growing confidence in the safety and effectiveness of TNFi use in pregnancy.