Initiating and stabilising
women on Cimzia®
(certolizumab pegol) before
conception may avoid
Cimzia should only be used in pregnancy if clinically needed.1
This section is designed to highlight the points in the treatment of a patient to motherhood, where treatment interventions may need to be made. Here we aim to show the potential burden associated with these interventions from both an NHS and a patient perspective.
We follow the story of a fictional patient called Sandra as she begins planning for motherhood and compare common scenarios with one that may reduce the need to make interventions.
She has been on a biologic for over 2 years now and her assessment scores are stable. She does not tolerate methotrexate and so takes her biologic as a monotherapy. Although Sandra suffers from the occasional flare, she manages these at home using paracetamol and ibuprofen when required. This is a long way from where she started when she was diagnosed at the age of 25.
Sandra and her husband have been considering starting a family for some time now. She has been particularly anxious about this as she has been told previously that she cannot take her biologic during pregnancy. Sandra's life prior to starting a biologic was difficult. She did not respond to traditional disease-modifying anti-rheumatic drugs (DMARDs) and the manifestations of the disease massively impacted on her work as a hairdresser.
During times of stress, she would develop bouts of scaly psoriasis on her hands, feet and face. The swelling of her joints in her fingers and wrists made work a struggle and the fatigue was wearing her down.
Sandra's Rheumatologist is aware of her desire to start a family and her treatment plan is discussed in a multidisciplinary team setting. See here for the impact on Sandra of different treatment decisions.
Discontinue the biologic before conception
Switch from a biologic that is contraindicated with pregnancy to another biologic that is not contraindicated with pregnancy, like Cimzia
Please refer to the Cimzia SmPC for further information.1
Due to the emerging biosimilar market, NHS trusts are being encouraged to use the best value biologic as their first line option.3 In addition to financial costs, it is important to consider the wider impact on the patient, their family and the NHS when a patient is on a treatment journey e.g. switching treatments, repeated hospital visits, loss of work days.4
Ultimately, a cost cannot be placed on the psychological aspects relating to the concerns of a woman trying for a baby, including being unfit to hold her newborn baby due to poor disease control.7
Cimzia should only be used during pregnancy if clinically needed
a Biologic treatment options for people with PsA NICE minimum requirements:21-25
Cimzia22 The person has had, and stopped responding to, a TNF inhibitor after the first 12 weeks
Ixekizumab24 The person has had, and stopped responding to a TNF inhibitor after or within the first 12 weeks, or TNF inhibitors are contraindicated
Seculkinumab22 The person has had, and stopped responding to a TNF inhibitor after or within the first 12 weeks, or TNF inhibitors are contraindicated
Ustekinumab25,d TNF inhibitors are contraindicated, or the person has had treatment with 1 or more TNF inhibitors
d The NICE minimum requirements listed above do not apply to ustekinumab, it can only be used in patients who meet the criteria listed under "Ustekinumab"25
The numbers of patients considered for these calculations are taken from the figures presented for pregnant women, breastfeeding women and those women who fall pregnant the following year (planned and unplanned).
It is assumed that 4 weeks are equivalent to 1 month and 13 weeks are equivalent to 3 months
Note that infliximab was excluded as it is administered in hospital and would not be given to patients to keep at home
a Cost of biologic treatment in PsA to calculate potential medicines waste30
b Over 12 months:
Patients who continued: 1.6 flares
Patients who stopped/changed: 3.1 flares
c The cost was calculated by multiplying the average increase in flares (1.5) by attendance cost
d A&E attendance for appropriate care without admission, assumed to require Category 2 Investigation with Category 3 Treatment at a Type 1 or 2 dept (HRG code VB05Z)
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