Anti-TNF Treatments for Women with Chronic Inflammatory Diseases: Comparing Attitudes and Perceptions of Physicians in Europe and the US

Introduction Chronic inflammatory disease (CID) activity in Women of Childbearing Age (WoCBA) is associated with higher risk of pregnancy complications and adverse outcomes. Tumour necrosis factor antagonists (anti-TNFs) are effective, but data on utilisation for these patients (pts) are limited. Objective/Hypothesis To understand physicians’ attitudes towards anti-TNF use around pregnancy, and differences between Europe- and US-based physicians. Methods The online survey was conducted in the US (Jul-17) and EU5 (France, Italy, Spain, UK, Germany; Nov/Dec-17). WoCBA were female pts aged 18–45. Participants included rheumatologists (RH) and obstetrician/gynaecologists (OB) among other healthcare professionals (HCPs). Results 203 US HCPs participated (50 RH, 50 OB) and 401 EU5 (152 RH, 114 OB). EU5 HCPs were less inclined to prescribe anti-TNFs for WoCBA; US RH (43%) had the highest proportion prescribed anti-TNFs (EU5 RH: 33%). Both US and EU5 HCPs’ comfort with prescribing anti-TNFs declined with onset of family planning. EU5 RH (61%) and OB (67%) were more likely to recommend stopping anti-TNFs pre-conception than US HCPs (RH: 46%; OB: 62%); similarly, > 50% EU5 RH and OB agreed women should stop anti-TNFs post-conception (US RH: 34%; OB: 54%). These findings may be due to more US RH strongly agreeing on making disease control during pregnancy a priority (42% vs EU5 RH: 25%) and that controlled disease reduces risk of pregnancy complications (US RH: 42%; EU5 RH: 28%), as well as more EU5 (34%) than US RH (12%) being very concerned about adverse events in pregnant pts on anti-TNFs. More EU5 (16%) than US RH (6%) strongly believed breastfeeding pts should not take anti-TNFs; uncertainty was high. Discussion Confidence in clinical management of WoCBA with CID varies, highlighting differences in physicians’ attitudes. Uncertainty and concerns about anti-TNFs for WoCBA are common, emphasising a need for better information/education of HCPs on anti-TNF use before/during/after pregnancy.