T2T Approach Can Increase Fertility in Women With RA

Nov 25, 2024

Photo Credit: Jacob Wackerhausen

Fertility in women with rheumatoid arthritis (RA) can be increased and approaches that of the general population when they are treated according to a treat-to-target (T2T) strategy aimed at remission. This was the main conclusion from a Dutch study, in which no direct relation between TNF inhibitor use and fertility was found.

Rates of infertility are 47% in women with RA compared with 10–15% in the general population. RA-related factors that influence fertility were previously studied in the Pregnancy-induced Amelioration of RA (PARA) cohort¹. These factors include age, nulliparity, disease activity, use of NSAIDs, and use of prednisone (>7.5 mg/day)². The results of the PARA study prompted the initiation of a new cohort, namely Preconception Counseling in Active RA (PreCARA). The PreCARA study then showed that in women who wish to conceive, a T2T approach aiming at remission but avoiding NSAIDs and high-dose prednisone is feasible³. To achieve this, sulfasalazine and hydroxychloroquine were prescribed plus, if needed, a TNF inhibitor or low-dose prednisone.

The Dutch group, led by study presenter Prof. Radboud Dolhain, MD, PhD, from the Erasmus University Medical Center, in the Netherlands, went on to investigate whether a T2T strategy in the PreCARA cohort (2012–2023) was associated with a shorter time to pregnancy than the PARA cohort (2002–2010).

The PreCARA and PARA cohorts had 215 and 245 participants, respectively. Prof. Dolhain noted that disease activity in the first trimester was significantly lower in the PreCARA cohort (DAS28 of 2.03 vs 3.48; P<0.01). In the PreCARA cohort, medication use was much more common, including TNF inhibitors (53% vs 4%; P<0.01).

The median time to pregnancy in the PreCARA cohort was 84 days (range: 0–298), in participants who got pregnant, compared with 196 days (77–464) in the PARA study (P<0.01). In the PreCARA cohort, 50 participants (23%) were not pregnant within 1 year; in the PARA cohort, this number was 102 (42%; P<0.01). Factors associated with pregnancy in the PreCARA cohort included maternal age per year (HR 0.95), and nulliparity (HR 0.69).

Medical writing support was provided by Michiel Tent