British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids

doi:10.1093/rheumatology/keac551

. 2023 Apr 3;62(4):e48-e88.

doi: 10.1093/rheumatology/keac551.

British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids

Mark D Russell¹, Mrinalini Dey², Julia Flint³, Philippa Davie¹, Alexander Allen⁴, Amy Crossley⁵, Margreta Frishman⁶, Mary Gayed⁷, Kenneth Hodson⁸, Munther Khamashta⁹, Louise Moore¹⁰, Sonia Panchal¹¹, Madeleine Piper¹², Clare Reid⁵, Katherine Saxby¹³, Karen Schreiber^{14

15

16}, Naz Senvar¹⁷, Sofia Tosounidou¹⁸, Maud van de Venne¹⁹, Louise Warburton²⁰, David Williams²¹, Chee-Seng Yee²², Caroline Gordon²³, Ian Giles²⁴; BSR Standards, Audit and Guidelines Working Group

Collaborators, Affiliations

Collaborators

BSR Standards, Audit and Guidelines Working Group:
Ian Giles, Ed Roddy, Kate Armon, Lauren Astell, Caroline Cotton, Alan Davidson, Sarah Fordham, Claire Jones, Christopher Joyce, Anoop Kuttikat, Zoe McLaren, Karen Merrison, Devesh Mewar, Amanda Mootoo, Emma Williams

Affiliations

¹ Centre for Rheumatic Diseases, King's College London, London, UK.
² Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
³ Department of Rheumatology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Shropshire, UK.
⁴ Clinical Affairs, British Society for Rheumatology, London, UK.
⁵ Patient Representative, UK.
⁶ Rheumatology, North Middlesex University Hospital NHS Trust, London, UK.
⁷ Rheumatology, Sandwell and West Birmingham Hospitals, Birmingham, UK.
⁸ UK Teratology Information Service, UK.
⁹ Lupus Research Unit, Division of Women's Health, King's College London, London, UK.
¹⁰ Rheumatic and Musculoskeletal Disease Unit, Our Lady's Hospice and Care Service, Dublin, Ireland.
¹¹ Department of Rheumatology, South Warwickshire NHS Foundation Trust, Warwickshire, UK.
¹² Royal National Hospital for Rheumatic Diseases, Royal United Hospital, Bath, UK.
¹³ Pharmacy, University College London Hospitals NHS Foundation Trust, London, UK.
¹⁴ Thrombosis and Haemostasis, Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹⁵ Department of Rheumatology, Danish Hospital for Rheumatic Diseases, Sonderborg, Denmark.
¹⁶ Department of Regional Health Research (IRS), University of Southern Denmark, Odense, Denmark.
¹⁷ Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK.
¹⁸ Lupus UK Centre of Excellence, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
¹⁹ Obstetrics & Gynaecology, Frimley Park Hospital, Surrey, UK.
²⁰ Primary Care and Health Sciences, Keele University, Keele, UK.
²¹ Obstetrics, University College London Hospitals NHS Foundation Trust, London, UK.
²² Department of Rheumatology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK.
²³ Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
²⁴ Centre for Rheumatology, Division of Medicine, University College London, London, UK.

PMID: 36318966
PMCID: PMC10070073
DOI: 10.1093/rheumatology/keac551

British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids

Mark D Russell et al. Rheumatology (Oxford). 2023.

. 2023 Apr 3;62(4):e48-e88.

doi: 10.1093/rheumatology/keac551.

Authors

Collaborators

BSR Standards, Audit and Guidelines Working Group:
Ian Giles, Ed Roddy, Kate Armon, Lauren Astell, Caroline Cotton, Alan Davidson, Sarah Fordham, Claire Jones, Christopher Joyce, Anoop Kuttikat, Zoe McLaren, Karen Merrison, Devesh Mewar, Amanda Mootoo, Emma Williams

Affiliations

¹ Centre for Rheumatic Diseases, King's College London, London, UK.
² Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
³ Department of Rheumatology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Shropshire, UK.
⁴ Clinical Affairs, British Society for Rheumatology, London, UK.
⁵ Patient Representative, UK.
⁶ Rheumatology, North Middlesex University Hospital NHS Trust, London, UK.
⁷ Rheumatology, Sandwell and West Birmingham Hospitals, Birmingham, UK.
⁸ UK Teratology Information Service, UK.
⁹ Lupus Research Unit, Division of Women's Health, King's College London, London, UK.
¹⁰ Rheumatic and Musculoskeletal Disease Unit, Our Lady's Hospice and Care Service, Dublin, Ireland.
¹¹ Department of Rheumatology, South Warwickshire NHS Foundation Trust, Warwickshire, UK.
¹² Royal National Hospital for Rheumatic Diseases, Royal United Hospital, Bath, UK.
¹³ Pharmacy, University College London Hospitals NHS Foundation Trust, London, UK.
¹⁴ Thrombosis and Haemostasis, Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹⁵ Department of Rheumatology, Danish Hospital for Rheumatic Diseases, Sonderborg, Denmark.
¹⁶ Department of Regional Health Research (IRS), University of Southern Denmark, Odense, Denmark.
¹⁷ Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK.
¹⁸ Lupus UK Centre of Excellence, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
¹⁹ Obstetrics & Gynaecology, Frimley Park Hospital, Surrey, UK.
²⁰ Primary Care and Health Sciences, Keele University, Keele, UK.
²¹ Obstetrics, University College London Hospitals NHS Foundation Trust, London, UK.
²² Department of Rheumatology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK.
²³ Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
²⁴ Centre for Rheumatology, Division of Medicine, University College London, London, UK.

PMID: 36318966
PMCID: PMC10070073
DOI: 10.1093/rheumatology/keac551

Erratum in

Correction to: British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids.
[No authors listed] [No authors listed] Rheumatology (Oxford). 2023 May 2;62(5):2021. doi: 10.1093/rheumatology/keac686. Rheumatology (Oxford). 2023. PMID: 36511437 Free PMC article. No abstract available.

No abstract available

Keywords: DMARDs; biologics; breastfeeding; breastmilk; corticosteroids; hydroxychloroquine; pregnancy; prescribing; rheumatic disease.

PubMed Disclaimer

Figures

**Figure 1.**
Flow diagram of studies selected for inclusion

See this image and copyright information in PMC

Comment in

Comment on: British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding.
Schreiber K, Frishman M, Hunt BJ. Schreiber K, et al. Rheumatology (Oxford). 2023 May 2;62(5):e164-e165. doi: 10.1093/rheumatology/keac700. Rheumatology (Oxford). 2023. PMID: 36545701 No abstract available.

Cited by

Periconceptional Counselling in Women with Autoimmune Inflammatory Rheumatic Diseases.
Rosta K, Binder J, Kuczwara V, Horvath M, Heinzl F, Hörhager C, Mayrhofer D, Mandl P, Fritsch-Stork R, Ott J, Mazzucato-Puchner A. Rosta K, et al. J Clin Med. 2024 Apr 24;13(9):2483. doi: 10.3390/jcm13092483. J Clin Med. 2024. PMID: 38731018 Free PMC article. Review.
2023 Management Recommendations of Bangladesh Rheumatology Society on Pharmacological Treatment of Rheumatoid Arthritis With Synthetic and Biologic Disease-Modifying Drugs.
Momen Majumder MS, Hasan ATMT, Choudhury MR, Ahmed S, Miah MT, Amin MR, Shahin MA, Islam A, Shazzad MN, Hassan MM, Ahmedullah AK, Rahman MM, Yesmeen S, Uddin T, Haq SA. Momen Majumder MS, et al. Cureus. 2024 Apr 30;16(4):e59395. doi: 10.7759/cureus.59395. eCollection 2024 Apr. Cureus. 2024. PMID: 38707172 Free PMC article. Review.
Management of pregnancy in autoimmune rheumatic diseases: maternal disease course, gestational and neonatal outcomes and use of medications in the prospectiveItalian P-RHEUM.it study.
Andreoli L, Gerardi MC, Gerosa M, Rozza D, Crisafulli F, Erra R, Lini D, Trespidi L, Padovan M, Ruffilli F, Serale F, Cuomo G, Raffeiner B, Semeraro P, Tani C, Chimenti MS, Conigliaro P, Hoxha A, Nalli C, Fredi M, Lazzaroni MG, Filippini M, Taglietti M, Franceschini F, Zatti S, Loardi C, Orabona R, Ramazzotto F, Zanardini C, Fontana G, Gozzoli G, Barison C, Bizioli P, Caporali RF, Carrea G, Ossola MW, Maranini B, Silvagni E, Govoni M, Morano D, Verteramo R, Doria A, Del Ross T, Favaro M, Calligaro A, Tonello M, Larosa M, Zen M, Zambon A, Mosca M, Zucchi D, Elefante E, Gori S, Iannone F, Anelli MG, Lavista M, Abbruzzese A, Fasano CG, D'Angelo S, Cutro MS, Picerno V, Carbone T, Padula AA, Rovere-Querini P, Canti V, De Lorenzo R, Cavallo L, Ramoni V, Montecucco C, Codullo V, Milanesi A, Pazzola G, Comitini G, Marvisi C, Salvarani C, Epis OM, Benedetti S, Di Raimondo G, Gagliardi C, Lomater C, Crepaldi G, Bellis E, Bellisai F, Garcia Gonzalez E, Pata AP, Zerbinati M, Urban ML, Mattioli I, Iuliano A, Sebastiani G, Brucato AL, Bizzi E, Cutolo M, Santo L, Tonetta S, Landolfi G, Carrara G, Bortoluzzi A, Scirè CA, Tincani A; P-RHEUM.it Investigators of the Italian Society for Rheumatology … See abstract for full author list ➔ Andreoli L, et al. RMD Open. 2024 Apr 24;10(2):e004091. doi: 10.1136/rmdopen-2024-004091. RMD Open. 2024. PMID: 38663885 Free PMC article.
Maternal and perinatal outcomes in pregnant women with rheumatic diseases treated with biosimilar TNF inhibitors.
Chícharo AT, Lopes AR, Barreira S, Pinto L, Cruz-Machado AR, Capela S. Chícharo AT, et al. Rheumatol Adv Pract. 2024 Mar 19;8(2):rkae044. doi: 10.1093/rap/rkae044. eCollection 2024. Rheumatol Adv Pract. 2024. PMID: 38590951 Free PMC article. No abstract available.
Interleukin-1 Blockers: A Paradigm Shift in the Treatment of Recurrent Pericarditis.
Lazarou E, Koutsianas C, Theofilis P, Lazaros G, Vassilopoulos D, Vlachopoulos C, Tsioufis C, Imazio M, Brucato A, Tousoulis D. Lazarou E, et al. Life (Basel). 2024 Feb 26;14(3):305. doi: 10.3390/life14030305. Life (Basel). 2024. PMID: 38541631 Free PMC article. Review.

See all "Cited by" articles

References

1. Flint J, Panchal S, Hurrell A. et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology 2016;55:1693–7. - PubMed
1. Flint J, Panchal S, Hurrell A. et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part II: analgesics and other drugs used in rheumatology practice. Rheumatology 2016;55:1698–702. - PubMed
1. Giles I, Allen A, Crossley A. et al. Prescribing anti-rheumatic drugs in pregnancy and breastfeeding - the BSR guideline scope. Rheumatology 2021;60:3565–9. - PubMed
1. Gotestam Skorpen C, Hoeltzenbein M, Tincani A. et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 2016;75:795–810. - PubMed
1. Andreoli L, Bertsias GK, Agmon-Levin N. et al. EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis 2017;76:476–85. - PMC - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- Genetic Alliance

[1] Flint J, Panchal S, Hurrell A. et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology 2016;55:1693–7. - PubMed

[2] Flint J, Panchal S, Hurrell A. et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology 2016;55:1693–7. - PubMed

[3] Flint J, Panchal S, Hurrell A. et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part II: analgesics and other drugs used in rheumatology practice. Rheumatology 2016;55:1698–702. - PubMed

[4] Flint J, Panchal S, Hurrell A. et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part II: analgesics and other drugs used in rheumatology practice. Rheumatology 2016;55:1698–702. - PubMed

[5] Giles I, Allen A, Crossley A. et al. Prescribing anti-rheumatic drugs in pregnancy and breastfeeding - the BSR guideline scope. Rheumatology 2021;60:3565–9. - PubMed

[6] Giles I, Allen A, Crossley A. et al. Prescribing anti-rheumatic drugs in pregnancy and breastfeeding - the BSR guideline scope. Rheumatology 2021;60:3565–9. - PubMed

[7] Gotestam Skorpen C, Hoeltzenbein M, Tincani A. et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 2016;75:795–810. - PubMed

[8] Gotestam Skorpen C, Hoeltzenbein M, Tincani A. et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 2016;75:795–810. - PubMed

[9] Andreoli L, Bertsias GK, Agmon-Levin N. et al. EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis 2017;76:476–85. - PMC - PubMed

[10] Andreoli L, Bertsias GK, Agmon-Levin N. et al. EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis 2017;76:476–85. - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids

Collaborators

Affiliations

British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids

Authors

Collaborators

Affiliations

Erratum in

Figures

Comment in

Similar articles

Cited by

References

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Erratum in

Figures

Comment in

Similar articles

Cited by

References

MeSH terms

Substances

Related information

LinkOut - more resources

Full Text Sources

Medical