Azathioprine and pregnancy

[Sezvic]

Hi all, I’m taking azathioprine 50mg twice a day and hydroxychloroquine 200mg twice a day for my Sle and Ra. I’ve mentioned to my rheumatologist in my last appointment that I’m trying for a baby. He told me if I got pregnant, he will need to stop my azathioprine because it will be toxic for my baby. I thought azathioprine was safe to take during pregnancy. I feel a bit confused now. I don’t want to be pregnant and flaring up. Please note it was not the same rheumatologist who started me azathioprine, the one who started me on azathioprine has left. Please anyone who has any advice about using azathioprine during pregnancy pm me and tell me your experience; if it’s safe or not. If my rheumatologist is not taking good care of me. I’m thinking of asking my GP for a referral at Guys and St Thomas hospital (lupus clinic).

[IMWilson]

Hi, I was advised to stop taking Azathioprine both before and when pregnant. I also was not able to breastfeed him due to risk of toxicity. This did not bother me as I was just relieved to have a reasonably (he was 6 weeks early and it was a very difficult pregnancy) healthy baby. I understand you want to keep healthy while trying for a baby and during so ask your gp for a referral for an appointment with an obstetrician. My gp did this because you will be classed as "at risk" with having Lupus and it is good to be under the care of someone who understands the whole picture. My son is now a very healthy young man. Good luck.

[Sezvic in reply to IMWilson]

Thank you for the reply. My rheumatologist has mentioned about being monitored by an obstetrician closely. I’m doing ivf as I got infertility problem.

[Paul_Howard Partner LUPUS UK]

Hi Sezvic ,

Most rheumatologists now agree that azathioprine is safe to continue during pregnancy based on the most recent reviews of clinical evidence. Many agree that it is safe to continue whilst breastfeeding too now, although I believe the evidence for this is more recent and is taking time to filter through.

The NICE accredited Guidelines for the Management of SLE in Adults published by the British Society for Rheumatology in October 2017 recommend azathioprine is safe during pregnancy and should be used as an alternative for other immunosuppressant treatments - academic.oup.com/rheumatolo...

Those recommendations came from this paper - academic.oup.com/rheumatolo...

[Sezvic]

Thank you Paul. I will have a look.

[Emily00]

Hi Sezvic , My rheumatologist said azathioprine is safe during pregnancy but flaring during pregnancy can be very dangerous for you and baby, and is more likely if you stop medicaitons. I believe they used to think it could be toxic but have since found no increased risk in studies.

You should definitely get a second opinion from a rheumatologist if this one wants to take you off the aza.