RMD Open (Nov 2024)

NSAID exposure delays time-to-pregnancy in patients with spondyloarthritis: an analysis of the GR2 prospective cohort

  • ,
  • Beatrice Banneville,
  • Arsène Mekinian,
  • Jérémie Sellam,
  • François Goffinet,
  • Maxime Dougados,
  • Eric Hachulla,
  • Nathalie Costedoat-Chalumeau,
  • Laure Gossec,
  • Anna Molto,
  • Frédéric Lioté,
  • Emmanuel Maheu,
  • Amélie Denis,
  • Anne-Sophie Korganow,
  • Christelle Sordet,
  • Emmanuelle Dernis,
  • Martin Soubrier,
  • Xavier Mariette,
  • Christophe Richez,
  • Benjamin Chaigne,
  • Hubert Marotte,
  • Laurent Perard,
  • Olivier Fain,
  • Nicolas Schleinitz,
  • Patrick Jégo,
  • Elisabeth Pasquier,
  • Sabine Berthier,
  • Claire Grange,
  • Marc Lambert,
  • Jonathan London,
  • Hélène Maillard,
  • François Maurier,
  • Alexis Régent,
  • Vincent Sobanski,
  • Grégory Pugnet,
  • Emmanuel Chatelus,
  • Jacques Morel,
  • Rene-Marc Flipo,
  • Emanuelle Dernis,
  • Alban Deroux,
  • Marc Fabre,
  • Marion Couderc,
  • Nihal Martis,
  • Martin Michaud,
  • Raphaele Seror,
  • Sophie Georgin-Lavialle,
  • Léa Savey,
  • Hervé Levesque,
  • Jean-Loup Pennaforte,
  • Rakiba Belkhir,
  • Maria Letizia Urban,
  • Sandra Desouches,
  • Elisabeth Gervais,
  • Augustin Latourte,
  • Aline Frazier,
  • Sabrina Hamroun,
  • Matthieu Mahevas,
  • Bertrand Godeau,
  • Marc Michel,
  • Cédric Lukas,
  • Pascal Cathébras,
  • Geoffrey Urbanski,
  • Holy Bezanahary,
  • Cecile Yelnik,
  • Ygal Benhamou,
  • Thierry Thomas,
  • Nicolas Martin-Silva,
  • Gaëlle Leroux,
  • Veronique Le Guern,
  • Claire Larroche,
  • Azeddine Dellal,
  • Guillaume Moulis,
  • Emilie Berthoux,
  • Fleur Cohen,
  • Guillaume Direz,
  • Nicole Ferreira-Maldent,
  • Antoine Froissart,
  • Vincent Langlois,
  • Agnès Portier,
  • Mélanie Roriz,
  • Boris Bienvenu,
  • Alice Berezne,
  • Claire Cazalets,
  • Aurelie Hummel,
  • Pascal Coquerelle,
  • Laurence Loeuillet,
  • Noémie Jourde-Chiche,
  • Claire Blanchard-Delaunay,
  • Moez Jallouli,
  • Cristina Belizna,
  • Isabelle Durieu,
  • Gaëlle Guettrot-Imbert,
  • Catherine Deneux-Tharaux,
  • Elisabeth Elefant,
  • Laetitia Dunogeant,
  • Anne Gompel,
  • Lisa Biale,
  • Agathe Masseau,
  • Elodie Chauvet,
  • Juliette Delforge,
  • Christian Lavigne,
  • Marie-Agnès Timsit,
  • Delphine Lariviere,
  • Evangeline Pillebout,
  • Antoinette Perlat,
  • Jean-Maxime Piot,
  • Vassilis Tsatsaris,
  • Mathilde de Menthon,
  • Claire de Moreuil,
  • Gaetan Sauvetre,
  • Loïc Raffray,
  • Jeremy Ora,
  • Celine Lartigau-Roussin,
  • Nathalie Tieulé,
  • Sara Melboucy-Belkhir,
  • Antoine Baudet,
  • Constance Beaudouin-Bazire,
  • Anne Calas,
  • Olivia Chandesris,
  • Jérémy Chatelais,
  • Marine Driessen,
  • Aurélie Du Thanh,
  • Cécile Durant,
  • Phillipe Goupille,
  • Constance Guillaud-Danis,
  • Stéphane Jobard,
  • Laurence Josselin-Mahr,
  • Thomas Le Gallou,
  • Valentine Loustau,
  • Hélène Petit Bauer,
  • Vincent Poindron Geneviève Plu-Bureau,
  • Jeremy Sellam,
  • Katia Stankovic-Stojanovic

DOI
https://doi.org/10.1136/rmdopen-2024-004745
Journal volume & issue
Vol. 10, no. 4

Abstract

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Background The impact of disease activity and treatment on fertility outcomes in patients with spondyloarthritis (SpA) has been little explored. This study aimed to describe median time to pregnancy (TTP) in women with SpA and the factors influencing TTP in this population.Methods This prospective observational multicentre (63 centres) French cohort (GR2 study—NCT02450396) included consecutive women with a diagnosis of SpA (according to their rheumatologist) who wanted to become pregnant between 2015 and 2021. TTP (in months) was the main outcome criterion, prospectively calculated from the date of study inclusion to the date of conception. Data on demographics, disease characteristics, disease activity, severity and treatment were prospectively collected at inclusion and each year thereafter until pregnancy occurred. TTP and its associated factors were estimated by survival analysis (Shared Frailty Cox models), with a random centre effect and multiple imputation to address missing data.Results We analysed 88 women included before conception. Among them, 56 (63.6%) became pregnant during follow-up. Median TTP was 16.1 (95% CI (12.2 to 25.3)) months. Mean preconceptional Bath Ankylosing Spondylitis Disease Activity Index at inclusion was 2.9 (±SD 2.1). Patients were treated with TNF inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs and glucocorticoids in 61 (69.3%), 23 (26.1%), 12 (13.6%) and 8 (9.1%) cases, respectively. The multivariate model found a significant association between TTP and age (HR) (per year) 1.22 95% CI (1.08 to 1.40); p<0.001) and the use of NSAIDs during preconception (HR 3.01 95% CI (2.15 to 3.85); p=0.01).Conclusion Age and NSAID use during preconception were significantly associated with a longer TTP, after adjustment for other confounding factors. These findings warrant caution in the use of NSAIDs in SpA patients trying to conceive.