SNOWMASS, COLO. — Lupus treatment should not be discontinued in anticipation of a pregnancy, Dr. W. Joseph McCune said at a symposium sponsored by the American College of Rheumatology.
Terminating drug treatment results in flares, and it is now clear that “there is really nothing worse for a lupus pregnancy than a flare, either immediately before the pregnancy or during the pregnancy,” said Dr. McCune, director of rheumatology outpatient services at the University of Michigan, Ann Arbor.
Instead of cessation of therapy, many physicians are trying to continue their patients on a corticosteroid (when necessary) and hydroxychloroquine, with informed consent and disclosure that the drug is known to cross the placenta.
Hydroxychloroquine is a drug that is not the most potent agent for resolving manifestations of lupus, but one that is very good at preventing serious disease developments and flares, Dr. McCune said.
Antimalarials have a number of potentially beneficial side effects, such as improving glucose tolerance, noted Dr. McCune, who previously reviewed and reported on evidence suggesting that antimalarials positively affect both cholesterol levels and thrombosis in lupus patients with increased cardiovascular risk.
There have been no apparent, adverse, fetal effects, and “in general, the experience has been that there have been no difficulties using this drug,” in recent reports of approximately 300 lupus patients treated with hydroxychloroquine during pregnancy, Dr. McCune said.
The reports are from various series and a blinded, placebo-controlled clinical trial.
In the 20 patient clinical trial, none of the 10 treated patients developed toxemia of pregnancy, while 3 of the 10 patients in the placebo group did. The infants of the treated mothers had a greater average delivery age and had a better average Apgar score. The hydroxychloroquine treated mothers used less prednisone (Lupus 2001;10:401–4).
There is also evidence from nonpregnant patients that hydroxychloroquine may positively impact antiphospholipid syndrome, which about 30% of lupus patients have, and which is associated with adverse pregnancy outcomes, Dr. McCune said.