The use and age of NSAIDs may delay conception in patients with spondyloarthritis

A new study presented this week at the 2022 ACR meeting at the American College of Rheumatology Annual Meeting showed that use of nonsteroidal anti-inflammatory drugs (NSAIDs) and older age were associated with longer time to conception in patients with spondyloarthritis (abstract #1673).

Spondyloarthritis (SpA) is a group of inflammatory diseases of the joints and spine with a variety of clinical manifestations
.
Although SpA is prevalent in people of childbearing age, little is known about the disease and its effects on fertility
.
The researchers conducted this prospective observational study to identify factors
that influence the timing of conception in patients with SpA.

Study participants included 88 patients with an average age of 31.
8 years (plus or minus 5 years) who were trying to conceive and were enrolled in the French multicenter GR2 cohort
from 2015 to June 2021.

Sabrina Hamroun, M.
D.
, lead author of the study and an associate professor at Coggin University Hospital in Paris, France, explains: "The GR2 cohort was followed from preconception or three trimesters until one year
after delivery.
" "During follow-up, the sociodemographic characteristics of the patient, the reception of various treatments, and disease activity
are regularly recorded.
The aim of this cohort study was to assess factors
related to timing of conception and obstetric morbidity in women with chronic inflammatory rheumatism and other conditions.
”

The primary endpoint of the study was time to conception, and the secondary endpoints were the number of infertile patients (who were conceived longer than 12 months or were not pregnant), and the number of people
who used traditional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologics during the preconception period.

The data showed that 56 of the 88 participants (63.
6%) became pregnant during the follow-up period, and 40 (45%) were identified as subfertile.

In this group, the mean time to conception was 16.
1 months
.
Twenty-three patients were treated with NSAIDs, 8 with corticosteroids, 12 with CSDMARD, and 61 with biologics
.
Multivariate models, adjusted for age, body mass index, duration and activity, smoking, SpA type, and preconception medication, showed a statistically significant increase
in NSAIDs use and the length of pregnancy at older ages.

Dr.
Hamroun noted that because the study participants were from tertiary centers, the findings may not be representative of all women of childbearing age with SpA in France, as patients with milder disease are usually treated
on an outpatient basis.
"We lack data on disease activity, and we deal with it with
multiple attribution," she said.
Therefore, we cannot exclude NSAIDs as agents of
disease activity.
In addition, there were no data on quality of life and frequency of sexual intercourse, variables that could affect the timing of conception
.
”

Nevertheless, Dr Hamrun said: "Studies have shown the impact
of NSAIDs use on SpA patients and their ability to conceive.
These results are also consistent with the mechanism of action of NSAIDs, the harmful effects of NSAIDs on fertilization that have been demonstrated
in other diseases.
In fact, a significant increase in the duration of pregnancy suggests that NSAIDs
should be used with caution or discontinued under supervision in patients with SpA who have difficulty conceiving pregnancy.
”

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