Advice to males with rheumatic diseases on non-biologic disease modifying anti-rheumatic (DMARD) therapy planning to conceive – A regional audit
David Brennan, Michelle McHenry
Department of Rheumatology, Musgrave Park Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
There are multiple male patients with rheumatic diseases who are of the appropriate age to conceive, and who are on non-biologic DMARD therapy. There is limited evidence relating to the impact of these therapies upon peri-conception paternal exposure and male fertility. The British Society of Rheumatology have issued some recommendations in their BSR and BHPR guideline on ‘prescribing drugs in pregnancy and breastfeeding—Part I: standard and biologic disease-modifying anti-rheumatic drugs and corticosteroids’ (published 10th January 2016), but not all medications have been included, and the evidence for these recommendations is limited.
To ascertain the current advice being given within the rheumatology departments in Northern Ireland to males with rheumatic diseases on non-biologic DMARD therapy who are planning to conceive.
An anonymous questionnaire was developed listing the common non-biologic DMARDs being used to treat rheumatic diseases. Respondents were asked to indicate if, and for how long, they asked male patients to discontinue these non-biologic DMARDs when planning to conceive. The questionnaire was distributed to Consultant Rheumatologists and Rheumatology Specialty Trainees working in Northern Ireland in October 2018.
There were 18 respondents, (response rate 54%). Below are tables summarising the responses for each of the non-biologic DMARDs listed in the questionnaire. Table 1 shows the percentage of respondents who recommend that the non-biologic DMARDs listed should be discontinued by male patients planning to conceive. Table 2 shows the duration of time that the respondents recommended discontinuing the non-biologic DMARDs prior to conception in males if advised to discontinue.
These results indicate that there is a variation in advice being given to male patients on non-biologic DMARDs who are planning to conceive. There is limited evidence on which to base current advice and guidance. More research into this area is needed. Registration of the relevant pregnancies with the Organization of Teratology Information Specialists (OTIS) will help to gather better evidence for the future. This will enable more informed decision making to be facilitated.