As many as six in ten women of childbearing age undergoing treatment with teratogenic disease-modifying anti-rheumatic drugs (DMARDs) are not using reliable contraception, according to an Australian rheumatologist and researcher.
Dr. Abhishikta Dey, a consultant rheumatologist at Royal Prince Alfred Hospital, expressed concern over the findings, which revealed that only 30 to 40% of these patients were using reliable contraception. Dr. Dey presented her research, part of her PhD work focusing on the use of medications in women of reproductive age with rheumatic diseases, at the combined New Zealand Rheumatology Association (NZRA) and Australian Rheumatology Association (ARA) Annual Scientific Meeting last weekend.
“I was not entirely surprised, because I’m seeing women on teratogenic medications who aren’t taking highly effective contraception,” Dr. Dey told The Medical Republic this week. “There’s a lot more room to improve.”
Dr. Dey, who has a special interest in osteoporosis, pregnancy considerations, and pain management in patients, highlighted the necessity for heightened awareness both in specialty and primary care settings. A conversation with a general practitioner (GP) colleague at the conference emphasized this point. The GP noted that when neurologists prescribe antiepileptics or dermatologists prescribe isotretinoin, it is made clear that appropriate contraception is necessary. However, this stringent guidance is not consistently provided when prescribing DMARDs.
“So I think we need to change that,” Dr. Dey said.
Methotrexate, leflunomide, and mycophenolate are particularly contraindicated during pregnancy due to the risk of fetal harm. “These three have either animal studies or human studies showing fetal harm, and so we would not want patients to be falling pregnant, if possible, on those medications,” Dr. Dey explained. “It doesn’t mean that everyone will definitely come to harm and that people have to have terminations, but it’s not the ideal setting.”
Dr. Dey also pointed out the importance of disease control before pregnancy. “You want patients to be well controlled from a disease activity point of view before considering pregnancy, so there’s another reason to use contraception.”
The full findings of Dr. Dey’s research are expected to be published in the coming months. She noted that while not all women taking these DMARDs would need to use reliable contraception—such as those not sexually active—it is a crucial conversation to have with all female patients of childbearing age. These discussions should be documented and communicated to the patient’s GP, who could then prescribe appropriate contraception.
Further follow-up should occur during patient reviews and prescription renewals, including discussions on pregnancy plans to potentially switch to pregnancy-compatible DMARDs that still offer effective disease control.
Part of Dr. Dey’s PhD work involves developing a guide for Australian rheumatologists, GPs, and patients on prescribing contraception to women being treated for musculoskeletal and inflammatory conditions. She hopes this guide will bridge the communication gap and increase the number of women using contraception while on teratogenic DMARDs.
“By raising awareness and improving communication between healthcare providers, we can significantly reduce the risk of unplanned pregnancies in women taking these medications,” Dr. Dey concluded.
