#5-38E. Breaking the Corticosteroid Chain: Unleashing Confidence in Prenatal TNFi Use (J Rheumatol, 2025)

How do we safely manage chronic inflammatory diseases in pregnant patients without compromising maternal or fetal health? In this episode, we discuss an editorial highlighting a crucial shift in reproductive rheumatology and gastroenterology. Historically, fear of medication-induced fetal harm led to frequent treatment discontinuation, which often triggered severe maternal disease flares. Paradoxically, managing these flares with prolonged corticosteroids posed significantly higher risks to both mother and child—such as maternal hypertension, preterm birth, and infant infections—compared to biologic therapy. The key clinical insight is that maintaining a 'treat-to-target' strategy with tumor necrosis factor inhibitors (TNFi) throughout pregnancy is not only safe but also offers a vital opportunity to taper and discontinue harmful corticosteroids. However, in critically appraising this paper, we must remember it is an editorial commentary rather than a primary clinical trial, and clinical recommendations still conflict with restrictive product labeling. For clinicians, this work is essential as it empowers shared decision-making, helping us transition from protecting patients from research to protecting them through research to optimize real-world perinatal outcomes.

Citation: Laura Andreoli, Mette Julsgaard, and Karen Schreiber. Confidence in the Use of Immunomodulatory Medications During Pregnancy: How Can Patient and Clinician Experience Be Improved?. The Journal of Rheumatology. 2025. DOI: 10.3899/jrheum.2025-0941

URL: https://doi.org/10.3899/jrheum.2025-0941

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.