Implications of Using TNF Inhibitors During Lactation

Megan E.B. Clowse, MD: I’ve been comfortable for quite a while using TNF [tumor necrosis factor] inhibitors in breastfeeding mothers, and I think that the CRADLE data are so exciting because they really demonstrate the safety of doing so. I think they will make many other rheumatologists comfortable with using these drugs in breastfeeding, as well. I know that rheumatologists and many other physicians think of lactation as sort of an extraneous “Oh, you can just skip it” kind of activity. But if you talk to young mothers, that is not how they see breastfeeding. Many women see it as an integral part to being a good mother, and so women will forgo medications for themselves. Women will suffer severe consequences in order to breastfeed. I hear stories from women that are just heartbreaking of the pain that they lived through because their doctors would not allow them to have medications while they were breastfeeding. That is unnecessary. It makes me so angry because it’s unnecessary. Women can take medications to manage their rheumatic disease while breastfeeding. It is perfectly safe for them. It is perfectly safe for their baby. I think it is our responsibility to really make that part of our practice. I really think that the CRADLE data provide solid, reliable, important data to make more rheumatologists comfortable with that decision.

It is my goal that all women with rheumatic disease can have the families that they dream of and that all rheumatologists in this country will help women get there. Up until now, rheumatologists have often stood in the way of allowing women to have children because of fear or worry or concern. But I think that the data we have now really tell us that the large majority of women with rheumatic disease can have safe, healthy pregnancies and healthy, happy families, and so it’s really my mission to make that a reality. That means that rheumatologists need to learn more and keep up with new data that are available.

The American College of Rheumatology is publishing the first-ever guidelines on reproductive health management for women with rheumatic disease here in the United States. I’m really excited about these guidelines. I hope that they will give doctors clear direction and the ability to make good decisions with their patients. We often are driven by fear of the unknown, and the goal of these guidelines is to give clarity and direction, even if there are data that are hard to interpret. So I’m hoping that this will really help transform the way that rheumatologists are addressing pregnancy with their patients and will give patients the ability to make good, healthy decisions.