A recent study published in Seminars in Arthritis and Rheumatism by Elsevier has provided reassuring news regarding the effects of biologic treatments on fertility in women with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). According to the study, biologic disease-modifying anti-rheumatic drugs (bDMARDs) do not negatively impact fertility.
The lead investigator, Dr. Einat Haikin Herzberger from Meir Medical Center and Tel Aviv University, along with her research team, highlighted that while biologic therapies are widely used, there is limited understanding of their potential effects on fertility. Prior research has indicated that women with RA tend to have fewer children than desired and experience longer times to conceive, along with higher rates of subfertility compared to the general population.
To investigate this further, Herzberger’s team conducted a retrospective cohort study using electronic health records (EHR) from 4,517 women with RA and 1,415 women with PsA, all between the ages of 18 and 40. The study included various biologics, such as tumor necrosis factor inhibitors, anti-CD-20 monoclonal antibodies, interleukin blockers, and T-cell inhibitors. The primary outcome measure was the rate of positive pregnancy tests, while secondary measures included the number of pregnancy attempts and use of in vitro fertilization (IVF).
The study revealed that the mean age at diagnosis and biologic initiation were similar between the two groups (RA: 30.7 years; PsA: 30.9 years), with no significant differences. Fertility rates were higher before the onset of these conditions, with positive beta-hCG test rates declining after diagnosis— from 84.5% to 63.6% in RA patients and from 87.1% to 61.4% in PsA patients. However, the initiation of biologic therapy did not further reduce these rates. Interestingly, women with PsA showed a slight trend toward increased fertility after beginning biologic treatment (P = .05), while fertility rates remained stable in the RA group.
Both groups experienced a rise in positive beta-hCG test rates after starting biologic treatment, with a statistically significant increase in the RA group (P < .01), and a near-significant trend in PsA patients (P = .07). When comparing fertility outcomes among women with RA or PsA who initiated biologic therapy with those who did not, there were no significant differences in the crude rates of positive pregnancy tests across all groups.
Fertility medication use before diagnosis was found to be similar in both groups, with about 8.3% of RA patients and 8.4% of PsA patients using fertility drugs. This percentage dropped after diagnosis but before biologic exposure, and later rebounded to 8.3% in RA patients and 7% in PsA patients. Notably, the IVF rate decreased in the RA group post-biologic treatment (P < .01), though it remained unchanged in the PsA group (P = .56).
Dr. Herzberger and colleagues concluded that their study offers reassuring evidence that biologic treatments do not negatively affect fertility in women with RA or PsA. They emphasized the need for further research to explore the effects of specific biologic agents and investigate live birth outcomes.
Related topics:
Rise in Fertility Treatments for Single Women and Female Couples, but Access Remains Limited
NJ Bill Seeks Fertility Preservation Coverage for Patients Facing Medical Risks
America’s Fertility Decline: A Demographic Puzzle with Economic Implications
