#2-64E. Optimizing RA Pregnancy Management: T2T and Biologic Continuation (Rheumatol, 2025)

How do we optimally balance maternal rheumatoid arthritis (RA) disease control with fetal safety during pregnancy, especially given limited therapeutic options? This episode reviews findings from the multicentre Japanese ANSWER cohort, a retrospective observational study examining the feasibility and impact of a treat-to-target (T2T) approach in 118 pregnancies complicated by RA. The application of T2T management was associated with favorable outcomes, maintaining remission or low disease activity in over 85% of patients throughout pregnancy and achieving full-term delivery in 92.8% of cases. Crucially, the data reveal that selective continuation of biologic DMARDs (bDMARDs) led to significantly lower DAS28-CRP scores during the second and third trimesters compared to discontinuation, underscoring the benefits of sustained potent therapy for maternal disease stability. However, clinicians must note that this retrospective observational design introduces the potential for selection bias in treatment decisions, and the study lacked long-term follow-up data for maternal and neonatal outcomes. These real-world findings are vital for physicians, providing robust evidence to support individualized T2T strategies—including the careful use of bDMARDs—to secure optimal disease control and reassuring pregnancy outcomes in RA patients.

Citation: Hiramatsu Y, Kotani T, Nakamura E, et al. Effect of treat-to-target strategies on maternal and neonatal outcomes of rheumatoid arthritis: a multicentre real-world ANSWER cohort study. Rheumatology. 2025. DOI: 10.1093/rheumatology/keaf558

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.