Dr. Chambers has received consulting fees from Merck, Orexigen Therapeutics, and Sanofi-Aventis (less than $10,000 each) and grant funding from Sanofi-Aventis.
Pregnancy outcome in women exposed to leflunomide before or during pregnancy
Version of Record online: 26 JUN 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 64, Issue 7, pages 2085–2094, July 2012
How to Cite
Cassina, M., Johnson, D. L., Robinson, L. K., Braddock, S. R., Xu, R., Jimenez, J. L., Mirrasoul, N., Salas, E., Luo, Y. J., Jones, K. L., Chambers, C. D. and for the Organization of Teratology Information Specialists Collaborative Research Group (2012), Pregnancy outcome in women exposed to leflunomide before or during pregnancy. Arthritis & Rheumatism, 64: 2085–2094. doi: 10.1002/art.34419
- Issue online: 26 JUN 2012
- Version of Record online: 26 JUN 2012
- Accepted manuscript online: 3 FEB 2012 02:38PM EST
- Manuscript Accepted: 31 JAN 2012
- Manuscript Received: 4 SEP 2011
Findings from animal studies have suggested that leflunomide may be a human teratogen. In the only human cohort study published to date, an increase in adverse outcomes in pregnancies after exposure to leflunomide was not detected. The aim of the present analysis was to expand on the previously published data with a description of birth outcomes among women who did not meet the previous cohort study criteria but who were exposed to leflunomide either during pregnancy or prior to conception.
Data on pregnancy exposures and outcomes were collected from 45 pregnant women who had contacted counseling services of the Organization of Teratology Information Specialists in the US or Canada between 1999 and 2009. Sixteen women were exposed to leflunomide during the first trimester of pregnancy and 29 women were exposed preconception.
All 16 of the pregnancies with leflunomide exposure during pregnancy and 27 (93%) of the pregnancies with exposure prior to conception resulted in liveborn infants. There were 2 infants with major malformations from mothers who were exposed during pregnancy, and no malformations reported in the preconception group. There was a potential known alternative etiology for at least some of the defects observed.
These data provide additional reassurance to women who inadvertently become pregnant while taking leflunomide and who undergo the washout procedure, as well as women who discontinue the medication prior to conception but have no prepregnancy documentation of drug clearance. However, until more conclusive data become available, women receiving leflunomide should be advised to use contraceptive methods and avoid pregnancy.