Use of Janus kinase inhibitors during early pregnancy in patients with rheumatic disease: a case series
4 affiliations
- 1Arthritis Research Canada, Vancouver, British Columbia, Canada
- 2Arthritis Research Canada, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Collaboration for Outcomes Research and Evaluation, Vancouver, British Columbia, Canada
- 3Arthritis Research Canada, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- 4Arthritis Research Canada, Vancouver, British Columbia, Canada; Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Abstract
Background: Janus kinase inhibitors (JAKi) are increasingly used to treat systemic autoimmune rheumatic diseases in patients of reproductive age, but pregnancy safety data remain limited. Current guidelines recommend discontinuation before conception and avoidance during pregnancy; however, inadvertent early exposures occur and create counselling uncertainty. Case summary: We identified 3 pregnancies with confirmed postconception JAKi exposure among 111 patients followed in a specialised pregnancy and rheumatic diseases clinic between July 2021 and September 2024. Two patients with psoriatic or seronegative inflammatory arthritis were exposed to upadacitinib 15 mg daily for 16 and 13 days after conception, respectively. One patient with rheumatoid arthritis was exposed to tofacitinib 5 mg twice daily for 30 days after conception. All JAKi were discontinued when pregnancy was recognised. One patient remained off immunosuppression until postpartum flare. One required prednisone and transitioned to certolizumab for a second-trimester inflammatory arthritis flare. One transitioned to hydroxychloroquine with stable disease. All pregnancies resulted in live births at 37 + 6 to 39 weeks. No congenital anomalies were identified. One infant, delivered by emergency caesarean section complicated by difficult fetal extraction, developed respiratory distress at birth and was admitted to the neonatal intensive care unit for 3 days for monitoring. The available documentation did not identify suspected or confirmed infection. Conclusions: These 3 cases add to limited real-world evidence regarding inadvertent first-trimester JAKi exposure in rheumatic disease. The findings are reassuring but cannot establish safety, and prospective data with longer infant follow-up remain needed.
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BibTeX
@article{needham2026janus,
title = {{Use of Janus kinase inhibitors during early pregnancy in patients with rheumatic disease: a case series}},
author = {Ainsley Needham and Vienna Cheng and Jeremiah Tan and Mary A. De Vera and Neda Amiri},
journal = {EULAR Rheumatology Open},
year = {2026},
month = oct,
doi = {10.1016/j.ero.2026.100240},
url = {https://doi.org/10.1016/j.ero.2026.100240},
note = {CC BY},
}
RIS
TY - JOUR
TI - Use of Janus kinase inhibitors during early pregnancy in patients with rheumatic disease: a case series
AU - Ainsley Needham
AU - Vienna Cheng
AU - Jeremiah Tan
AU - Mary A. De Vera
AU - Neda Amiri
PY - 2026
DA - 2026/10/22
JO - EULAR Rheumatology Open
DO - 10.1016/j.ero.2026.100240
UR - https://doi.org/10.1016/j.ero.2026.100240
AB - Background: Janus kinase inhibitors (JAKi) are increasingly used to treat systemic autoimmune rheumatic diseases in patients of reproductive age, but pregnancy safety data remain limited. Current guidelines recommend discontinuation before conception and avoidance during pregnancy; however, inadvertent early exposures occur and create counselling uncertainty. Case summary: We identified 3 pregnancies with confirmed postconception JAKi exposure among 111 patients followed in a specialised pregnancy and rheumatic diseases clinic between July 2021 and September 2024. Two patients with psoriatic or seronegative inflammatory arthritis were exposed to upadacitinib 15 mg daily for 16 and 13 days after conception, respectively. One patient with rheumatoid arthritis was exposed to tofacitinib 5 mg twice daily for 30 days after conception. All JAKi were discontinued when pregnancy was recognised. One patient remained off immunosuppression until postpartum flare. One required prednisone and transitioned to certolizumab for a second-trimester inflammatory arthritis flare. One transitioned to hydroxychloroquine with stable disease. All pregnancies resulted in live births at 37 + 6 to 39 weeks. No congenital anomalies were identified. One infant, delivered by emergency caesarean section complicated by difficult fetal extraction, developed respiratory distress at birth and was admitted to the neonatal intensive care unit for 3 days for monitoring. The available documentation did not identify suspected or confirmed infection. Conclusions: These 3 cases add to limited real-world evidence regarding inadvertent first-trimester JAKi exposure in rheumatic disease. The findings are reassuring but cannot establish safety, and prospective data with longer infant follow-up remain needed.
SN - 3050-7081
ER -