2109 - Contraception Use in Women with Rheumatoid Arthritis

Tuesday, November 8, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Megan E. B. Clowse, Duke University Medical Center, Durham, NC, Eliza F. Chakravarty, Stanford University, Palo Alto, CA, Karen H. Costenbader, Brigham and Women's Hospital, Boston, MA, Christina Chambers, University of California, San Diego, La Jolla, CA, Frederick Wolfe, National Data Bank for Rheumatic Diseases, Wichita, KS and Kaleb Michaud, National Data Bank for Rheumatic Diseases, University of Nebraska, Omaha, NE
Presentation Number: 2109

Background/Purpose: Women of reproductive age are frequently prescribed potentially teratogenic medications making the use of effective contraception of utmost importance.  Pregnancies conceived while taking these medications have a higher rate of miscarriage and the decision whether to continue the pregnancy can be difficult.  The frequency of contraceptive use in women with RA is little studied and whether this rate if different for women taking potentially teratogenic medications is unknown.  

Method: A one-time reproductive health questionnaire was sent to women in a large prospective cohort.  Premenopausal women who were not trying to conceive were asked to report the methods they had used to avoid pregnancy in the prior year.  Forms of contraception were divided into three categories:  ineffective (no method, abstinence, withdrawal, rhythm, and barrier methods); effective (hormonal contraceptives or an intrauterine device (IUD)); and sterilization (either the woman or her partner had surgically sterilization).  Women could report multiple forms of contraception; they were classified according to the most effective method reported.  The current medications from the most recent biannual cohort questionnaire were merged with the reproductive health questionnaire results.  Medications were analyzed according to the FDA pregnancy classification indicating the degree of potential risk to a fetus from in utero drug exposure.

Result:  108 premenopausal women with RA completed this questionnaire.  Ineffective contraception was used by 33% of women; including 16 who reported that they used no contraception, 11 who used abstinence, 4 withdrawal, 3 the rhythm method, and 9 who used barrier methods.  Effective contraception was used by 22% of women; including 21 using hormonal contraception and 4 with an IUD.  The remaining 45% were sterilized; including 22 with a tubal ligation and 26 with a partner with a vasectomy .

FDA class X medications (methotrexate and/or leflunamide) were taken by 56% of women.  Of these, 28% used ineffective contraception, 23% used effective contraception, and 48% were sterile. 

Hydroxychloroquine (FDA class C) was used by 19% of women, 30% of whom used ineffective contraception, 35% used effective contraception, and 35% were sterile.  Sulfasalazine (FDA class B) was only used by 6 women, 1 using ineffective contraception, 2 using effective, and 3 sterile.

TNF-inhibitors (FDA class B) were used by 53% of the women.  Of these, 40% used ineffective contraception, 25% used effective contraception, and 35% were sterile.  Other biologics, which included abatacept and rituximab, (both FDA class C) were used by 13 women, of whom 23% used ineffective contraception and 77% were sterile.

Conclusion: Almost half of women with RA in this cohort took FDA class X medications and 29% of these women were using ineffective contraception, leaving them at high risk for pregnancy.  This study highlights the importance of contraceptive education and prescription by rheumatologists to ensure that patients taking potentially teratogenic medications do not become pregnant.

Keywords: methotrexate (MTX), rheumatoid arthritis (RA) and women's health

Disclosure: M. E. B. Clowse, None; E. F. Chakravarty, Exagen Diagnostics, 2 ; K. H. Costenbader, None; C. Chambers, Abbott Laboratories, 2 ; F. Wolfe, None; K. Michaud, None.