title: Tocilizumab and pregnancy: Four cases of pregnancy in young women with rheumatoid arthritis refractory to anti-TNF biologics with exposure to tocilizumab.
abstract: OBJECTIVE
  To investigate the use of tocilizumab (TCZ) in pregnant patients with active rheumatoid arthritis (RA) refractory to anti-tumour necrosis factor (TNF) agents.
  
  
  METHODS
  We retrospectively analysed the medical records of pregnant women with active RA treated between July 2008 and January 2015 by the Division of Maternal Medicine at our hospital. Inclusion criteria for this case series included active RA refractory to anti-TNF agents and exposure to TCZ at the time of conception.
  
  
  RESULTS
  Our review of 28 patient hospital records identified four patients who met the inclusion criteria. All four patients had active synovitis before starting treatment with TCZ. Successful TCZ therapy allowed them to plan to become pregnant. When pregnancy was confirmed, TCZ was terminated as soon as possible in all patients. Three patients delivered full-term infants without any adverse outcomes. One patient had a partial molar pregnancy and miscarried during gestational week 11. Two patients remained in clinical remission with low-dose prednisolone (PSL) or no treatment for RA during pregnancy.
  
  
  CONCLUSIONS
  TCZ may be a good alternative therapy for RA patients with symptoms that are hard to control with TNF blockers who desire to bear children.
authors.affiliation: a Division of Maternal Medicine , Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development , Tokyo , Japan.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Kaneko
authors.affiliation: a Division of Maternal Medicine , Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development , Tokyo , Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Sugitani
authors.affiliation: a Division of Maternal Medicine , Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development , Tokyo , Japan.
authors.forename: Mikako
authors.initials: M
authors.lastname: Goto
authors.affiliation: a Division of Maternal Medicine , Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development , Tokyo , Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Murashima
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D011239:Prednisolone / Q000627:therapeutic use; D011247:Pregnancy; D011256:Pregnancy Outcome; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D011239:Prednisolone; C502936:tocilizumab
keywords: Pregnancy; Rheumatoid arthritis; Tocilizumab