Treat-To-Target Approach Boosts Fertility Outcomes In Women With Rheumatoid Arthritis

narrowing the gap between their time-to-pregnancy and that of the general population.

RA, an autoimmune disease that causes chronic inflammation in the joints, is known to impair fertility in women. This can be particularly distressing for women trying to conceive, as the disease often disrupts hormonal balance and overall reproductive health. However, new data suggests that adopting a treat-to-target approach focused on disease remission can significantly reduce the time to conception.

What is the Treat-to-Target Approach?

The treat-to-target (T2T) strategy involves closely monitoring disease activity and adjusting treatment to achieve specific goals, such as disease remission or low disease activity. For women with RA looking to conceive, this approach emphasizes minimizing inflammation while ensuring medications are compatible with pregnancy.

Under the T2T paradigm, a combination of medications such as sulfasalazine, hydroxychloroquine, and TNF inhibitors, alongside low-dose prednisone when necessary, are used to manage RA symptoms.

New Findings on Fertility in Women with RA

The Preconception Counseling in Active RA (PreCARA) study provided valuable insights into how the T2T approach impacts fertility. Researchers analyzed data from 245 women in the PreCARA cohort and compared it with 215 women from an earlier study known as the Pregnancy-induced Amelioration of RA (PARA) cohort, which did not utilize the T2T strategy.

Key findings include:

• Time-to-Pregnancy Improvement: Women in the PreCARA cohort had a median time to pregnancy of 84 days—less than half the 196-day median observed in the PARA group.
• Lower Infertility Rates: Only 23% of PreCARA participants took longer than 12 months to conceive, compared to 42% in the PARA group.
• Better Disease Control: PreCARA participants had a lower average disease activity score (DAS28 CRP of 2.33) compared to the PARA group (DAS28 of 3.84).

The findings suggest that achieving and maintaining low disease activity before conception plays a crucial role in improving fertility outcomes.

Medication Use in Preconception Period

A critical aspect of the study was evaluating medication use during the preconception period:

• Fewer Steroids: Only 23% of PreCARA participants using prednisone exceeded a daily dose of 7.5 mg, compared to 48% in the PARA group.
• Increased Biologic Use: Over half (53%) of PreCARA patients used TNF inhibitors, compared to just 3% in the PARA cohort.

This shift in medication patterns, prioritizing biologics over higher steroid doses, aligns with the T2T strategy’s goal of minimizing systemic inflammation with fewer side effects.

Fertility Nearly Equal to General Population

“These findings are encouraging,” noted Dr. Radboud Dolhain, a lead researcher in the study. “With a treat-to-target approach, fertility outcomes in women with RA are nearly on par with those in the general population.”

For many women with RA, this represents a significant milestone. By achieving disease control and utilizing medications compatible with pregnancy, the T2T approach provides hope for women aspiring to start families while managing their condition.

The Path Forward

This study highlights the importance of personalized care in managing RA for women planning pregnancy. Rheumatologists are encouraged to adopt T2T strategies and collaborate with patients to optimize both disease control and reproductive health.

As research continues, the insights from the PreCARA study offer a compelling case for integrating treat-to-target approaches into standard RA care, especially for women navigating the dual challenges of managing their condition and building their families.

Reference – https://www.healio.com/news/rheumatology/20241126/treattotarget-approach-improves-fertility-in-women-with-rheumatoid-arthritis