Two Successful Pregnancies in a Woman with Rheumatoid Arthritis Treated by Etanercept and Tocilizumab

Abstract

We report the case of a woman with rheumatoid arthritis (RA) who had two successful pregnancies (at 31 and 35 years old). Her RA was diagnosed when she was 23 years old. The first pregnancy was established while she was taking etanercept (ETN) and prednisolone (PSL) after In Vitro Fertilization - Blastocyst Transfer (IVF-BT). Her RA was controlled well by ETN/PSL during pregnancy and she gave birth to a healthy female infant weighing 2650 g with Apgar scores of 7 and 9. The RA worsened transiently after childbirth and methotrexate (MTX) was administered. Based on her desire to have a second child, MTX was discontinued. Her second pregnancy was established while on PSL/tocilizmab (TCZ) after IVF-BT. The TCZ was halted until gestational week (GW) 8, two doses of TCZ were given at GW 9 and 14 to stabilize RA, TCZ was switched to ETN on and after GW 18, and she gave birth to a healthy male infant weighing 3225 g with Apgar scores of 8 and 9. Counseling was provided several times by a pharmacist to support her RA treatment during her pregnancy.