Drug utilization patterns during pre-conception and pregnancy period in women with systemic lupus erythematosus in Korea

초록

Background: Proper use of effective and safe medication during pregnancy in women with systemic lupus erythematosus (SLE) is a key to a successful pregnancy outcome. Hence, examining the drug utilization patterns in pregnant women with SLE provides a better understanding of clinical practice during pregnancies in SLE patients. Objectives: To assess the drug utilization patterns of women with SLE during two preconception periods and pregnancy period and changes in treatment patterns after conception. Methods: A descriptive, cross-sectional study was conducted using the National Health Insurance Service database of Korea between 2002 and 2018. The study population was women of childbearing age (15–49 years) with SLE who had 1) records of both ICD-10 codes for pregnancy and HIRA procedure codes for delivery or abortion 2) the first conception between Jan 1, 2010, and Dec 31, 2017, 3) at least two years of SLE diagnosis before the conception date. The frequency of SLE medications for disease control as hydroxychloroquine, methotrexate, azathioprine, tacrolimus, mycophenolate mofetil, cyclophosphamide, and rituximab was mainly examined during the pre-conception period and pregnancy period (PP). We assessed the changes in medications with known association with adverse pregnancy outcomes (methotrexate, mycophenolate mofetil, cyclophosphamide, and rituximab) during PP, compared with two pre-conception periods (24 to 12 months before conception (PC1); 12 months before conception (PC2)). Results: A total of 1019 SLE women were included in this study. The average maternal age of SLE women was 31.6 years (standard deviation of 3.9). Only 59 and 56 percent of patients were prescribed antimalarial drugs during PC1 and PC2, respectively, and the proportion dropped to 32 % during PP. Approximately 22 % of patients were not on disease-control therapy and were prescribed only short relief of therapy during PC2. Drug use was decreased in all therapy after conception, and the proportion of patients receiving no treatment increased up to 51.4 % of all pregnant women. Methotrexate, mycophenolate mofetil, cyclophosphamide, and rituximab were discontinued in 100, 96, 83, and 100 percent of patients after conception, respectively. Conclusions: After conception, methotrexate, mycophenolate mofetil, cyclophosphamide, and rituximab was discontinued in most patients. The proportion of hydroxychloroquine use, though recommended for all SLE patients, including pregnant women, also decreased after conception. A conservative approach to discontinuing medications in SLE pregnancy was observed in this study.