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Scriffignano S, Perrotta FM, Lubrano E. Male Fertility in Spondyloarthritis: from Clinical Issues to Cytokines Milieu. A Narrative Review. Curr Rheumatol Rep 2024:10.1007/s11926-024-01153-w. [PMID: 38900205 DOI: 10.1007/s11926-024-01153-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
PURPOSEOF REVIEW Male fertility is an emergent issue that should be considered in clinical practice, when dealing with chronic inflammatory diseases in young men. As it is known, the chronic inflammation is the main pathophysiologic mechanism in some rheumatological conditions such as spondyloarthritis (SpA), Ankylosing Spondylitis (AS) and Psoriatic Arthritis (PsA). Therefore, it is paramount to be aware if these diseases could impair male fertility, both due to the inflammation or to the treatments needed: we reviewed the literature on the most relevant and recent evidence on male fertility in patients affected by SpA, AS and PsA. RECENT FINDINGS Rheumatological inflammatory diseases (included SpA, AS and PsA) could impair the family planning in man life, especially when diagnosed at young age. Moreover, focusing on sperm quality, it seems that a link between sperm quality impairment and a higher disease activity exist. Focusing on therapies, Tumor Necrosis Factor inhibitors showed a safety profile on human male fertility in clinical studies. Recently, a prospective study and two double-blind placebo-controlled trials assessed the impact of methotrexate and Filgotinib on semen parameters, respectively, showing a safety profile of these drugs on human semen quality. However, there are no clinical data on the impact of Interleukin (IL)17 inhibitors(i), IL12-23i and IL23i. Concerning male fertility in SpA, AS and PsA, an unmet clinical need is still present and new studies are needed to understand the association between these diseases and male fertility, and the implication of the therapies used for these diseases. This narrative review provides an overview of the available data on male fertility in patients affected by SpA, AS and PsA.
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Affiliation(s)
- Silvia Scriffignano
- Academic Rheumatology Unit, Dipartimento Di Medicina E Scienze, Della Salute "Vincenzo Tiberio", Università Degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy
| | - Fabio Massimo Perrotta
- Academic Rheumatology Unit, Dipartimento Di Medicina E Scienze, Della Salute "Vincenzo Tiberio", Università Degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento Di Medicina E Scienze, Della Salute "Vincenzo Tiberio", Università Degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy.
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Yessirkepov M, Kocyigit BF, Zhakipbekov K, Adilbekov E, Sultanbekov K, Akaltun MS. Uncovering the link between inflammatory rheumatic diseases and male reproductive health: a perspective on male infertility and sexual dysfunction. Rheumatol Int 2024:10.1007/s00296-024-05602-8. [PMID: 38693253 DOI: 10.1007/s00296-024-05602-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
Inflammatory rheumatic diseases (IRDs) refer to a range of persistent disorders that have a major influence on several physiological systems. Although there is much evidence connecting IRDs to sexual dysfunction and fertility problems, research specifically focusing on male infertility in relation to these diseases is sparse. This review addresses the complicated connection between IRDs and male infertility, emphasising the physiological, psychological, and pharmacological aspects that influence reproductive health outcomes in men with rheumatic conditions. We explore the effects of IRDs and their treatments on many facets of male reproductive well-being, encompassing sexual functionality, semen characteristics, and hormonal balance. Additionally, we present a comprehensive analysis of the present knowledge on the impact of several categories of anti-rheumatic drugs on male reproductive function. Although there is an increasing awareness of the need of addressing reproductive concerns in individuals IRDs, there is a noticeable lack of research especially dedicated to male infertility. Moving forward, more comprehensive research is needed to determine the prevalence, risk factors, and mechanisms driving reproductive difficulties in males with IRDs. We can better assist the reproductive health requirements of male IRD patients by expanding our understanding of male infertility in the setting of rheumatic disorders and implementing holistic methods to care.
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Affiliation(s)
- Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Burhan Fatih Kocyigit
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana City Research and Training Hospital, Adana, Türkiye, Turkey
| | - Kairat Zhakipbekov
- Department of Organization and Management and Economics of Pharmacy and Clinical Pharmacy, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Kassymkhan Sultanbekov
- Department Social Health Insurance and Public Health, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Mazlum Serdar Akaltun
- Faculty of Medicine, Department of Physical Medicine and Rehabilitaton, Gaziantep University, Gaziantep, Türkiye, Turkey.
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Sigmo GD, Hauge S, Hufthammer KO, Wallenius M, Salvesen KÅ, Daltveit AKN, Bakland G, Fevang BTS. Male patients with inflammatory joint diseases are less likely than controls to be childless: results from a Norwegian population-based cohort study of 10 865 patients. Ann Rheum Dis 2024; 83:457-463. [PMID: 38262688 PMCID: PMC10958328 DOI: 10.1136/ard-2023-224998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/25/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To investigate the number of children per man and the proportion of childless men as a proxy of fertility in a national cohort of men with inflammatory joint diseases (IJDs), compared with matched controls from the general population. METHODS This is a nationwide, population-based retrospective cohort study. Male patients with IJDs (n = 10 865) in the Norwegian Arthritis Registry were individually matched 1:5 on birth year and county of residence with men without IJDs obtained from the National Population Register (n = 54 325). Birth data were obtained from the Medical Birth Registry of Norway. We compared the mean number of children per man and the proportion of childless men and analysed the impact of age and year of diagnosis. RESULTS The mean number of children per man in the patient group was 1.80 versus 1.69 in the comparison group (p <0.001), and 21% of the patients in the patient group were childless versus 27% in the comparison group (p <0.001). The finding of less childlessness and higher number of children per man remained consistent across age at diagnosis, except for those diagnosed at age 0-19 years. The difference in childlessness was most pronounced for men diagnosed after year 2000, especially when diagnosed at 30-39 years of age (22% vs 32%, p<0.001). CONCLUSION In this large cohort study we found that patients with IJD have a higher number of children and are less likely to be childless compared with controls. Factors associated with developing or having an IJD might influence fertility and this requires further investigation.
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Affiliation(s)
- Gudrun David Sigmo
- Department of Rheumatology, Stavanger University Hospital, Stavanger, Norway
| | - Solveig Hauge
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | | | - Marianne Wallenius
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Kjell Åsmund Salvesen
- Department of Obstetrics and Gynecology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Kjersti Nesje Daltveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Medical Birth Registry, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
- Department of Rheumatology, University of Tromsø, Tromsø, Norway
| | - Bjorg-Tilde Svanes Fevang
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Alhamam A, Garabed LR, Julian S, Flannigan R. The association of medications and supplements with human male reproductive health: a systematic review. Fertil Steril 2023; 120:1112-1137. [PMID: 37898470 DOI: 10.1016/j.fertnstert.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
Some medications used to treat comorbidities and conditions in reproductive-aged individuals could have a negative impact on fertility. This may occur through hormonal disruption, toxicity to germ cells and spermatozoa, functional impact on the sperm, teratogenicity potential, or ejaculatory abnormalities. Having knowledge of these potential interactions between medications and reproductive potential is important for clinicians to be aware of and guide the patient, along with their treating clinicians, to reproductively favorable alternatives when available. This review aims to summarize the state of the literature regarding medication interactions with human male reproduction using the Anatomical Therapeutic Chemical Classification System of medications.
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Affiliation(s)
- Abdullah Alhamam
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Laurianne Rita Garabed
- Division of Urology, Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Sania Julian
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan Flannigan
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urology, Weill Cornell Medicine, New York, New York.
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Rheumatic Diseases in Reproductive Age-the Possibilities and the Risks. Reprod Sci 2023; 30:111-123. [PMID: 35359225 DOI: 10.1007/s43032-022-00901-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/20/2022] [Indexed: 01/11/2023]
Abstract
The most common systemic connective tissue diseases (CTD), such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), systemic sclerosis (SSc), and Sjögren's syndrome (SjS), affect many women of reproductive age. These diseases may strongly impact the course of pregnancy and increase the risk factors of incompatibility. A literature search was done on MEDLINE, PubMed, and Google Scholar in 2011-2021. The analysis included meta-analysis, randomized control trials, prospective and retrospective studies, and systematic reviews. The literature search allowed us to form conclusions and underline recommendations regarding pregnancy's risk and treatment possibilities in the course of rheumatic disease. Optimal control of CTD activity should be reached at least 6 months before conception. High-risk pregnancies are often accompanied by maternal-placental syndrome, which manifests as preeclampsia, eclampsia, fetal growth restriction, and prematurity. The flare of rheumatic disease can coexist with obstetrical complications, and differential diagnosis can be difficult. Medications that do not influence the risk of fetus complications should be applied before and during pregnancy. Teratogenic drugs (e.g., methotrexate, leflunomide, cyclophosphamide) must be withdrawn before pregnancy. Conventional medications such as hydroxychloroquine, sulfasalazine, colchicine, and the TNFα inhibitor certolizumab can be used safely at any stage of pregnancy. Corticosteroids should be tapered, and other biologics should be avoided due to teratogenicity or carefully administered due to the impact on the fetal immune system. Distinguishing between disease flare and obstetrical complications can be difficult in clinical practice; however, some clinical symptoms and serological markers can be helpful in the differential diagnosis.
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Rives N, Courbière B, Almont T, Kassab D, Berger C, Grynberg M, Papaxanthos A, Decanter C, Elefant E, Dhedin N, Barraud-Lange V, Béranger MC, Demoor-Goldschmidt C, Frédérique N, Bergère M, Gabrel L, Duperray M, Vermel C, Hoog-Labouret N, Pibarot M, Provansal M, Quéro L, Lejeune H, Methorst C, Saias J, Véronique-Baudin J, Giscard d'Estaing S, Farsi F, Poirot C, Huyghe É. What should be done in terms of fertility preservation for patients with cancer? The French 2021 guidelines. Eur J Cancer 2022; 173:146-166. [PMID: 35932626 DOI: 10.1016/j.ejca.2022.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 11/03/2022]
Abstract
AIM To provide practice guidelines about fertility preservation (FP) in oncology. METHODS We selected 400 articles after a PubMed review of the literature (1987-2019). RECOMMENDATIONS Any child, adolescent and adult of reproductive age should be informed about the risk of treatment gonadotoxicity. In women, systematically proposed FP counselling between 15 and 38 years of age in case of treatment including bifunctional alkylating agents, above 6 g/m2 cyclophosphamide equivalent dose (CED), and for radiation doses on the ovaries ≥3 Gy. For postmenarchal patients, oocyte cryopreservation after ovarian stimulation is the first-line FP technique. Ovarian tissue cryopreservation should be discussed as a first-line approach in case of treatment with a high gonadotoxic risk, when chemotherapy has already started and in urgent cases. Ovarian transposition is to be discussed prior to pelvic radiotherapy involving a high risk of premature ovarian failure. For prepubertal girls, ovarian tissue cryopreservation should be proposed in the case of treatment with a high gonadotoxic risk. In pubertal males, sperm cryopreservation must be systematically offered to any male who is to undergo cancer treatment, regardless of toxicity. Testicular tissue cryopreservation must be proposed in males unable to cryopreserve sperm who are to undergo a treatment with intermediate or severe risk of gonadotoxicity. In prepubertal boys, testicular tissue preservation is: - recommended for chemotherapy with a CED ≥7500 mg/m2 or radiotherapy ≥3 Gy on both testicles. - proposed for chemotherapy with a CED ≥5.000 mg/m2 or radiotherapy ≥2 Gy. If several possible strategies, the ultimate choice is made by the patient.
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Affiliation(s)
- Nathalie Rives
- Normandie Univ, UNIROUEN, Team "Adrenal and Gonadal Physiopathology" Inserm U1239 Nordic, Rouen University Hospital, Biology of Reproduction-CECOS Laboratory, Rouen, France
| | - Blandine Courbière
- Reproductive Medicine and Biology Department, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Thierry Almont
- Cancerology, Urology, Hematology Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France; General Cancer Registry of Martinique UF1441, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Diana Kassab
- Methodology Unit, Association Française d'Urologie, Paris, Ile-de-France, France
| | - Claire Berger
- Department of Pediatric Hematology and Oncology, University-Hospital of Saint-Etienne, Hospital, Nord Saint-Etienne cedex 02, France 42055; Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne, 15 rue Ambroise Paré, Saint-Etienne cedex 02, France 42023
| | - Michaël Grynberg
- Reproductive Medicine and Fertility Department, Hôpital Antoine-Beclère, Clamart, Île-de-France, France
| | - Aline Papaxanthos
- Reproductive Medicine and Biology Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
| | - Christine Decanter
- Medically Assisted Procreation and Fertility Preservation Department, Centre Hospitalier Régional Universitaire de Lille, Lille, Hauts-de-France, France
| | - Elisabeth Elefant
- Reference Center for Teratogenic Agents, Hôpital Armand-Trousseau Centre de Référence sur les Agents Tératogènes, Paris, Île-de-France, France
| | - Nathalie Dhedin
- Adolescents and Young Adults Unit, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, France
| | - Virginie Barraud-Lange
- Reproductive Medicine and Biology Department, Hôpital Cochin, Paris, Île-de-France, France
| | | | | | - Nicollet Frédérique
- Information and Promotion Department, Association Laurette Fugain, Paris, France
| | - Marianne Bergère
- Human Reproduction, Embryology and Genetics Directorate, Agence de la biomédecine, La Plaine Saint-Denis, France
| | - Lydie Gabrel
- Good Practices Unit - Guidelines and Medicines Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Marianne Duperray
- Guidelines and Drug Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Christine Vermel
- Expertise Quality and Compliance Mission - Communication and Information Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Natalie Hoog-Labouret
- Research and Innovation, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Michèle Pibarot
- OncoPaca-Corse Regional Cancer Network, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Magali Provansal
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Laurent Quéro
- Cancerology and Radiotherapy Department, Hôpital Saint Louis, AP-HP, Paris, France
| | - Hervé Lejeune
- Reproductive Medicine and Biology Department, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Charlotte Methorst
- Reproductive Medicine and Biology Department, Centre Hospitalier des Quatre Villes - Site de Saint-Cloud, Saint-Cloud, France
| | - Jacqueline Saias
- Reproductive Medicine and Biology Department, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Jacqueline Véronique-Baudin
- Cancerology, Urology, Hematology Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France; General Cancer Registry of Martinique UF1441, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Sandrine Giscard d'Estaing
- Reproductive Medicine and Biology Department, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Fadila Farsi
- Regional Cancer Network, Réseau Espace Santé Cancer, Lyon, Rhône-Alpes, France
| | - Catherine Poirot
- Adolescents and Young Adults Unit, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, France
| | - Éric Huyghe
- Urology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Laboratoire Développement Embryonnaire, Fertilité et Environnement (DEFE) UMR 1203, Université Toulouse 3 Paul Sabatier, Toulouse, France.
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Chatzimeletiou K, Fleva A, Sioga A, Georgiou I, Nikolopoulos TT, Markopoulou M, Petrogiannis N, Anifandis G, Patrikiou A, Kolibianakis E, Giannakou A, Grimbizis G. Effects of Different Drug Therapies and COVID-19 mRNA Vaccination on Semen Quality in a Man with Ankylosing Spondylitis: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:173. [PMID: 35208497 PMCID: PMC8875133 DOI: 10.3390/medicina58020173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Ankylosing spondylitis (AS) is a condition that affects 0.1% to 0.5% of the adult population. The aim of this case report was to investigate the possible effects of the drugs taken for treatment of AS as well as mRNA vaccination for COVID-19 on semen quality by performing a highly detailed analysis. Materials and Methods: Sperm characteristics were examined by light microscopy, DNA fragmentation (DFI) was analysed by flow cytometry and morphology was evaluated by transmission electron microscopy (TEM). Results: Semen analysis under therapy with (1) celecoxib and sulphasalazine showed: concentration 47 million/mL, 53% progressive motility, 7% normal morphology and 9.6% DFI, (2) Golimumab and before mRNA Vaccination showed: concentration 108 million/mL, 82% progressive motility, 1% normal morphology and 7.6% DFI, and (3) Golimumab and after 3 doses of mRNA Vaccination showed: concentration 142 million/mL, 85% progressive motility, 1% normal morphology and 6.8% DFI. TEM revealed head, neck and tail abnormalities, as well as the presence of cells with incomplete spermiogenesis white cells and phagocytes in the sample under therapy with celecoxib and sulphasalazine. Golimumab treatment lead to an increased incidence of elongated heads but in general reduced inflammation as no white cells were evident in TEM. Conclusion: The anti-inflamatory drugs celecoxib and sulphasalazine had no adverse effect on sperm quality as all parameters were within normal limits and the patient achieved under that treatment 2 pregnancies following natural conception that lead to the birth of a healthy boy and girl respectively. Anti-TNFa treatment with Golimumab exerted a negative effect on morphology but not on concentration, motility and DFI. After 3 doses of mRNA Vaccination, sperm concentration increased while motility, morphology and DFI remained similar to the values before vaccination suggesting no negative effect of the mRNA vaccine for COVID-19 on sperm quality.
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Affiliation(s)
- Katerina Chatzimeletiou
- Unit for Human Reproduction, 1st Department of Obstetrics & Gynaecology, ‘Papageorgiou’ General Hospital, Aristotle University Medical School, 56403 Thessaloniki, Greece; (T.-T.N.); (A.P.); (E.K.); (G.G.)
| | - Alexandra Fleva
- Department of Immunology and Histocompatibility, ‘Papageorgiou’ General Hospital, 56403 Thessaloniki, Greece; (A.F.); (M.M.); (A.G.)
| | - Antonia Sioga
- Laboratory of Histology and Embryology, Aristotle University Medical School, 54124 Thessaloniki, Greece;
| | - Ioannis Georgiou
- Laboratory of Medical Genetics, School of Medicine, University of Ioannina and Medical Genetics and Assisted Reproduction Unit, Department of Obstetrics and Gynecology, University Hospital of Ioannina, 45110 Ioannina, Greece;
| | - Theodoros-Thomas Nikolopoulos
- Unit for Human Reproduction, 1st Department of Obstetrics & Gynaecology, ‘Papageorgiou’ General Hospital, Aristotle University Medical School, 56403 Thessaloniki, Greece; (T.-T.N.); (A.P.); (E.K.); (G.G.)
| | - Maria Markopoulou
- Department of Immunology and Histocompatibility, ‘Papageorgiou’ General Hospital, 56403 Thessaloniki, Greece; (A.F.); (M.M.); (A.G.)
| | | | - George Anifandis
- Department of Obstetrics and Gynecology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41200 Larisa, Greece;
| | - Antonios Patrikiou
- Unit for Human Reproduction, 1st Department of Obstetrics & Gynaecology, ‘Papageorgiou’ General Hospital, Aristotle University Medical School, 56403 Thessaloniki, Greece; (T.-T.N.); (A.P.); (E.K.); (G.G.)
| | - Efstratios Kolibianakis
- Unit for Human Reproduction, 1st Department of Obstetrics & Gynaecology, ‘Papageorgiou’ General Hospital, Aristotle University Medical School, 56403 Thessaloniki, Greece; (T.-T.N.); (A.P.); (E.K.); (G.G.)
| | - Anastasia Giannakou
- Department of Immunology and Histocompatibility, ‘Papageorgiou’ General Hospital, 56403 Thessaloniki, Greece; (A.F.); (M.M.); (A.G.)
| | - Grigoris Grimbizis
- Unit for Human Reproduction, 1st Department of Obstetrics & Gynaecology, ‘Papageorgiou’ General Hospital, Aristotle University Medical School, 56403 Thessaloniki, Greece; (T.-T.N.); (A.P.); (E.K.); (G.G.)
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8
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Boussaid S, Makhlouf Y, Rekik S, Jammali S, Cheour E, Sahli H, Elleuch M, Ben Saad H. The effects of autoimmune rheumatic-related diseases on male reproductive health: A systematic review. J Reprod Immunol 2022; 150:103472. [PMID: 34998078 DOI: 10.1016/j.jri.2021.103472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/24/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
Abstract
Autoimmune rheumatic-related diseases (ARRDs) have physical and psychological impact on patients, including their sexual life. While many studies have investigated fertility problems in females, data on males-related fertility are scarce, which explains the lack of guidance. The main objective of this systematic review was to evaluate the reproductive health in males with ARRDs. This systematic review followed the preferred reporting items for systematic reviews guidelines. Original articles from Pubmed and Scopus, published until September 16, 2021, and tackling the effects of ARRDs and/or ARRDs treatments on male fertility and/or pregnancy outcomes, were included. A total of twenty-five studies met the inclusion criteria. They were published between 1981 and 2018. The studied ARRDs were spondyloarthritis (n = 9), systematic lupus erythematosus (SLE, n = 6), Behcet disease (BD, n = 5), rheumatoid arthritis (RA, n = 5), antiphospholipid syndrome (n = 1), and dermatomyositis (n = 1). The most reported effects of ARRDs on fertility are i) high levels of reproductive hormones, mainly in RA and SLE; ii) impaired semen quality in SLE, spondyloarthritis, and BD; and iii) higher rate of varicocele in BD and spondyloarthritis. Regarding the treatments effects, i) conventional synthetic disease-modifying anti-rheumatic drugs (e.g.; methotrexate and salazopyrine) increase testosterone level, ii) cyclophosphamide impairs fertility, iii) anti-tumor necrosis factor agents are associated with improvement in semen quality, and iv) no increased number of miscarriages or congenital abnormalities in children fathered by BD was reported. To conclude, both ARRDs and their treatments alter fertility in males with ARRDs. In practice, in addition to the conventional semen analysis, screening for infertility seems legitimate in males with ARRDs.
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Affiliation(s)
- Soumaya Boussaid
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia; Research Unit LR 05 SP 01, la Rabta Hospital, Tunisia.
| | - Yasmine Makhlouf
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.
| | - Sonia Rekik
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia; Research Unit LR 05 SP 01, la Rabta Hospital, Tunisia.
| | - Samia Jammali
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia; Research Unit LR 05 SP 01, la Rabta Hospital, Tunisia.
| | - Elhem Cheour
- Pain Treatment center, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia; Research Unit LR 05 SP 01, la Rabta Hospital, Tunisia.
| | - Hela Sahli
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia; Research Unit LR 05 SP 01, la Rabta Hospital, Tunisia.
| | - Mohamed Elleuch
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.
| | - Helmi Ben Saad
- Université de Sousse, Faculté de Médecine de Sousse, Service de Physiologie et Explorations Fonctionnelles, Sousse, Tunisie; Université de Sousse, Hôpital Farhat HACHED, Service de Physiologie et Explorations Fonctionnelles, Sousse, Tunisia; Université de Sousse, Hôpital Farhat HACHED, Laboratoire de recherche LR12SP09 «Insuffisance cardiaque», Sousse, Tunisia.
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9
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Formulas, Algorithms and Examples for Binomial Distributed Data Confidence Interval Calculation: Excess Risk, Relative Risk and Odds Ratio. MATHEMATICS 2021. [DOI: 10.3390/math9192506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Medical studies often involve a comparison between two outcomes, each collected from a sample. The probability associated with, and confidence in the result of the study is of most importance, since one may argue that having been wrong with a percent could be what killed a patient. Sampling is usually done from a finite and discrete population and it follows a Bernoulli trial, leading to a contingency of two binomially distributed samples (better known as 2×2 contingency table). Current guidelines recommend reporting relative measures of association (such as the relative risk and odds ratio) in conjunction with absolute measures of association (which include risk difference or excess risk). Because the distribution is discrete, the evaluation of the exact confidence interval for either of those measures of association is a mathematical challenge. Some alternate scenarios were analyzed (continuous vs. discrete; hypergeometric vs. binomial), and in the main case—bivariate binomial experiment—a strategy for providing exact p-values and confidence intervals is proposed. Algorithms implementing the strategy are given.
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10
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Holcomb ZE, Porter ML, Kimball AB. A safety review of biologic therapies for the management of hidradenitis suppurativa and unmet needs. Expert Opin Drug Saf 2021; 20:1147-1161. [PMID: 33910441 DOI: 10.1080/14740338.2021.1924147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory skin disorder characterized by nodules, abscesses, fistulae, and significant scarring in intertriginous areas rich in apocrine glands. Immunomodulator drugs, including biologics, are a mainstay of treatment for this disease. AREAS COVERED This review details the safety profiles of various biologic therapies currently available commercially that have been tried for HS as assessed in clinical trials and observational studies. As the only Food and Drug Administration (FDA)-approved medication for the treatment of moderate-to-severe HS, adalimumab is discussed in the most detail. Additional biologic medications, including tumor necrosis factor α (TNFα) inhibitors, interleukin 1 (IL-1) inhibitors, IL-12 and IL-23 inhibitors, IL-17 inhibitors, and IL-23 inhibitors, are discussed as well. Safety concerns in special populations, including pregnant women and children, are outlined. EXPERT OPINION Existing data support excellent short-term and long-term safety profiles for adalimumab, although caution must be taken with use in high-risk patient populations, including those with chronic infections or increased risk of malignancy. Based on their safety data for other indications, additional biologic agents appear safe in HS as well. However, further research is needed to fully understand the safety profiles of these medications in the HS population.
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Affiliation(s)
- Zachary E Holcomb
- Department of Dermatology, Massachusetts General Hospital, Harvard Combined Dermatology Residency Program, Boston, MA, USA
| | - Martina L Porter
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - Alexa B Kimball
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Dermatology, Harvard Medical School, Boston, MA, USA
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11
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Perez-Garcia LF, Dolhain RJEM, Vorstenbosch S, Bramer W, van Puijenbroek E, Hazes JMW, Te Winkel B. The effect of paternal exposure to immunosuppressive drugs on sexual function, reproductive hormones, fertility, pregnancy and offspring outcomes: a systematic review. Hum Reprod Update 2021; 26:961-1001. [PMID: 32743663 PMCID: PMC7600290 DOI: 10.1093/humupd/dmaa022] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/17/2020] [Accepted: 05/01/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Information regarding the possible influence of immunosuppressive drugs on male sexual function and reproductive outcomes is scarce. Men diagnosed with immune-mediated diseases and a wish to become a father represent an important neglected population since they lack vital information to make balanced decisions about their treatment. OBJECTIVE AND RATIONALE The aim of this research was to systematically review the literature for the influence of paternal immunosuppressive drug use on many aspects of male sexual health, such as sexual function, fertility, pregnancy outcomes and offspring health outcomes. SEARCH METHODS A systematic literature search was performed in the bibliographic databases: Embase (via Elsevier embase.com), MEDLINE ALL via Ovid, Cochrane Central Register of Trials (via Wiley) and Web of Science Core Collection. Additionally, Google Scholar and the Clinical trial registries of Europe and the USA were searched. The databases were searched from inception until 31 August 2019. The searches combined keywords regarding male sexual function and fertility, pregnancy outcomes and offspring health with a list of immunosuppressive drugs. Studies were included if they were published in English and if they included original data on male human exposure to immunosuppressive drugs. A meta-analysis was not possible to perform due to the heterogeneity of the data. OUTCOMES A total of 5867 references were identified, amongst which we identified 161 articles fulfilling the eligibility criteria. Amongst these articles, 50 included pregnancy and offspring outcomes and 130 included sexual health outcomes. Except for large Scandinavian cohorts, most of the identified articles included a small number of participants. While a clear negative effect on sperm quality was evident for sulfasalazine and cyclophosphamide, a dubious effect was identified for colchicine, methotrexate and sirolimus. In three articles, exposure to tumour necrosis factor-α inhibitors in patients diagnosed with ankylosing spondylitis resulted in improved sperm quality. The information regarding pregnancy and offspring outcomes was scant but no large negative effect associated with paternal immunosuppressive drug exposure was reported. WIDER IMPLICATIONS Evidence regarding the safety of immunosuppressive drugs in men with a wish to become a father is inconclusive. The lack of standardisation on how to evaluate and report male sexual function, fertility and reproduction as study outcomes in men exposed to immunosuppressive drugs is an important contributor to this result. Future research on this topic is needed and should be preferably done using standardised methods.
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Affiliation(s)
- L F Perez-Garcia
- Department of Rheumatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - R J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - S Vorstenbosch
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH 's-Hertogenbosch, The Netherlands
| | - W Bramer
- Medical Library, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - E van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH 's-Hertogenbosch, The Netherlands.,Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology and Economics, University of Groningen, 9712 CP Groningen, The Netherlands
| | - J M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - B Te Winkel
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH 's-Hertogenbosch, The Netherlands
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12
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Romanowska-Próchnicka K, Felis-Giemza A, Olesińska M, Wojdasiewicz P, Paradowska-Gorycka A, Szukiewicz D. The Role of TNF-α and Anti-TNF-α Agents during Preconception, Pregnancy, and Breastfeeding. Int J Mol Sci 2021; 22:ijms22062922. [PMID: 33805757 PMCID: PMC7998738 DOI: 10.3390/ijms22062922] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/11/2021] [Indexed: 12/15/2022] Open
Abstract
Tumor necrosis factor-alpha (TNF-α) is a multifunctional Th1 cytokine and one of the most important inflammatory cytokines. In pregnancy, TNF-α influences hormone synthesis, placental architecture, and embryonic development. It was also shown that increased levels of TNF-α are associated with pregnancy loss and preeclampsia. Increased TNF-α levels in complicated pregnancy draw attention to trophoblast biology, especially migratory activity, syncytialisation, and endocrine function. Additionally, elevated TNF-α levels may affect the maternal-fetal relationship by altering the secretory profile of placental immunomodulatory factors, which in turn affects maternal immune cells. There is growing evidence that metabolic/pro-inflammatory cytokines can program early placental functions and growth in the first trimester of pregnancy. Furthermore, early pregnancy placenta has a direct impact on fetal development and maternal immune system diseases that release inflammatory (e.g., TNF-α) and immunomodulatory factors, such as chronic inflammatory rheumatic, gastroenterological, or dermatological diseases, and may result in an abnormal release of cytokines and chemokines in syncytiotrophoblasts. Pregnancy poses a challenge in the treatment of chronic disease in patients who plan to have children. The activity of the disease, the impact of pregnancy on the course of the disease, and the safety of pharmacotherapy, including anti-rheumatic agents, in pregnancy should be considered.
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Affiliation(s)
- Katarzyna Romanowska-Próchnicka
- Department of Biophysics and Human Physiology, Faculty of Health Sciences, Warsaw Medical University, 02-091 Warsaw, Poland; (K.R.-P.); (P.W.); (D.S.)
- Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
| | - Anna Felis-Giemza
- Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
- Correspondence:
| | - Marzena Olesińska
- Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
| | - Piotr Wojdasiewicz
- Department of Biophysics and Human Physiology, Faculty of Health Sciences, Warsaw Medical University, 02-091 Warsaw, Poland; (K.R.-P.); (P.W.); (D.S.)
| | - Agnieszka Paradowska-Gorycka
- Department of Molecular Biology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
| | - Dariusz Szukiewicz
- Department of Biophysics and Human Physiology, Faculty of Health Sciences, Warsaw Medical University, 02-091 Warsaw, Poland; (K.R.-P.); (P.W.); (D.S.)
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13
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Cao RH, Grimm MC. Pregnancy and medications in inflammatory bowel disease. Obstet Med 2021; 14:4-11. [PMID: 33995565 PMCID: PMC8107959 DOI: 10.1177/1753495x20919214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/20/2020] [Accepted: 02/21/2020] [Indexed: 12/27/2022] Open
Abstract
Inflammatory bowel disease (IBD) affects patients at a significant time in their lives, often coinciding with family planning or pregnancy. While advances in IBD therapies have afforded women greater opportunities for successful conception and pregnancy outcomes, there still remains considerable maternal fear surrounding continuation of treatment in pregnancy. With the exception of methotrexate, most IBD drugs are safe and well tolerated during pregnancy and are not associated with significant risk of adverse fetal or pregnancy outcomes. Furthermore, the current evidence overwhelmingly suggests that good control of disease activity and clinical remission at time of conception are the greatest prognostic factors for an uncomplicated pregnancy and maintenance of quiescent disease. Management of pregnant women with IBD should involve discussions with the mother and family about fears or concerns surrounding the impact of IBD on pregnancy. Mothers should be supported and counselled carefully on the safety and importance of adherence to therapy in maintaining remission. Optimal management of these women requires an inter-disciplinary team effort, involving the general practitioner, in close consultation with both gastroenterologists and obstetricians.
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Affiliation(s)
- Rena H Cao
- St George and Sutherland Clinical School,
University of New South Wales, Sydney, Australia
| | - Michael C Grimm
- St George and Sutherland Clinical School,
University of New South Wales, Sydney, Australia
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14
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Beltagy A, Aghamajidi A, Trespidi L, Ossola W, Meroni PL. Biologics During Pregnancy and Breastfeeding Among Women With Rheumatic Diseases: Safety Clinical Evidence on the Road. Front Pharmacol 2021; 12:621247. [PMID: 34122062 PMCID: PMC8189556 DOI: 10.3389/fphar.2021.621247] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/04/2021] [Indexed: 12/31/2022] Open
Abstract
Females are generally more affected by autoimmune diseases, a fact that underlines the relationship with pregnancy and the safety of anti-rheumatic drugs in pregnancy and lactation. Biologic therapies are increasingly prescribed to treat and maintain remission in a significant number of systemic autoimmune rheumatic diseases. The experience with the use of biologics during gestation is extremely lacking because of the observational nature of the available studies and the difficulty in designing proper clinical trials in pregnancy. Among the studied biologics, more information was published on TNFα inhibitors and, in particular, on their potential passage through the placenta and impact on the fetus. Currently, a fragment of anti-TNFα monoclonal IgG, certolizumab pegol, is considered safe with almost no placental transfer. Subsequent observations are suggesting a comparable safety for the soluble TNFα receptor etanercept. Another biologic, eculizumab, the anti-C5a antibody used to treat complement-mediated microangiopathies, is also considered safe due to the unique engineered IgG2/4κ formulation that limits its passage through the placental barrier. Still, long-term data about children born to women treated with biologics in pregnancy are not attainable. Data on breastfeeding are currently available for several biologics. This article reviews the literature available about which drugs are considered safe during pregnancy and lactation, which are not, and on future prospects.
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Affiliation(s)
- Asmaa Beltagy
- Istituto Auxologico Italiano, IRCCS, Immunorheumatology Research Laboratory, Milan, Italy.,Rheumatology and Clinical Immunology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Azin Aghamajidi
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Laura Trespidi
- Department of Obstetrics and Gynaecology, Fondazione Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Wally Ossola
- Department of Obstetrics and Gynaecology, Fondazione Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Pier Luigi Meroni
- Istituto Auxologico Italiano, IRCCS, Immunorheumatology Research Laboratory, Milan, Italy
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15
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Finelli R, Leisegang K, Finocchi F, De Masi S, Agarwal A, Damiani G. The impact of autoimmune systemic inflammation and associated medications on male reproductive health in patients with chronic rheumatological, dermatological, and gastroenterological diseases: A systematic review. Am J Reprod Immunol 2021; 85:e13389. [PMID: 33420722 DOI: 10.1111/aji.13389] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/04/2021] [Indexed: 01/13/2023] Open
Abstract
Autoimmune disorders currently affect 5%-8% of the global population, characterized by an aberrant chronic inflammatory response to self-antigens. The aim of this study was to systematically review the current available evidence investigating the impact of systemic autoimmune diseases and associated immunosuppressive treatment on fertility parameters of adult men. Clinical trials, observational studies, and case reports written in English and reporting semen analysis, evaluation of seminal oxidative stress, and/or sperm DNA fragmentation in patients affected by psoriasis and psoriatic arthritis, celiac disease, inflammatory bowel diseases, systemic lupus erythematosus, ankylosing spondylitis, hidradenitis suppurativa, uveitis, dermatomyositis, and rheumatoid arthritis were collected by searching on PubMed, EMBASE, OVID, Scopus, and Cochrane Library databases, with no limit of time. The study quality and the extent of bias in design, methods, and outcome assessment were evaluated by applying the Joanna Briggs Institute Critical Appraisal tools. Evidence suggested that various autoimmune diseases or relevant medications can adversely affect male fertility parameters and that patients may benefit of counseling and sperm cryopreservation. Clinical trials further investigating any adverse effect of autoimmunity and related thereby on male infertility are warranted, to develop appropriate guidelines for males diagnosed and treated for autoimmune disorders.
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Affiliation(s)
- Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kristian Leisegang
- School of Natural Medicine, University of the Western Cape, Cape Town, South Africa
| | - Federica Finocchi
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | | | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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16
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Abbasi-Oshaghi E, Khodadadi I, Mirzaei F, Ahmadi M, Tayebinia H, Goodarzi MT. Anethum graveolens L.
Alleviates Sperm Damage by Limiting Oxidative Stress and Insulin Resistance in Diabetic Rats . THE OPEN MEDICINAL CHEMISTRY JOURNAL 2020. [DOI: 10.2174/1874104502014010035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background:
It has been reported that diabetes is associated with sperm damage and infertility.
Objective:
The purpose of this experiment was to survey the effect of Anethum graveolens L. (Dill) powder on sperm profiles, oxidative stress, insulin resistance, and histological changes in male diabetic rats.
Methods:
Male rats were randomly divided into 6 groups (n=7); group 1: normal rats, 2: normal rats + 100mg/kg Dill, 3: normal rats + 300mg/kg Dill, 4: diabetic rats, 5: diabetic rats + 100mg/kg Dill, and 6: diabetic rats + 300mg/kg Dill. After 2 months of treatments, the sperm profile, anti-oxidant activity, superoxide dismutase (SOD) activity, and malondialdehyde were measured. The histopathology of testis was evaluated. Hormonal changes and tumor necrosis factor-α (TNF-α) levels were measured by ELISA.
Results:
Total anti-oxidant and SOD activity in diabetic rats significantly decreased, while MDA concentration was significantly increased in the testis and pancreas of diabetic rats compared with control. However, the use of Dill significantly normalized these profiles. The treatment of diabetic rats with Dill changed the sperm parameters. The levels of testosterone, FSH, and LH in diabetic rats were significantly reduced, but the treatment with Dill did not alter the level of these hormones. Dill also significantly normalized testis morphological changes, insulin resistance, and inflammation.
Conclusion:
The use of Dill normalized oxidative stress, inflammation, and insulin resistance in diabetic rats that correlated with sperm profile and testis histological changes. The treatment of diabetic rat models with Dill did not show harmful effects on sperm profiles.
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17
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Cooley LF, Wren J, Keeter MK, Lam I, Bennett N, Brannigan RE. Anti-TNF agents and potential effects on male fertility: are men being counseled? BMC Urol 2020; 20:111. [PMID: 32718310 PMCID: PMC7385975 DOI: 10.1186/s12894-020-00658-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Adult men with autoimmune conditions are commonly prescribed anti-tumor necrosis factor (anti-TNF) agents; however, there is a paucity of quality evidence as to their effect on male fertility (e.g. semen parameters and sperm quality). Our objective was to determine if men with autoimmune conditions are being counseled regarding the unknown reproductive effects of anti-TNF agents prior to initiation of therapy. METHODS A retrospective analysis of 1010 male patients age 18-45 who were prescribed an anti-TNF agent were assessed for (1) receipt of counseling regarding potential reproductive effects; (2) screening for anatomic or laboratory abnormalities associated with infertility; (3) election for sperm cryopreservation. RESULTS Only 10.3% of men received counseling, and this was not associated with age (p = 0.77). Those who received counseling were significantly more likely to have a genitourinary exam performed, be assessed for presence of a varicocele, be asked about or endorse low libido or erectile dysfunction, have a testosterone, LH, FSH, or prolactin level checked, and have a semen analysis performed (all, p < 0.0001). Rates of sperm cryopreservation were low, but statistically higher in men who received counseling (5.77% (+) counseling, 1.10% (-) counseling) (p = 0.002). CONCLUSIONS The limited current literature lacks a consensus regarding the short- and long-term male reproductive effects of anti-TNF therapy. Despite this lack of clarity, rates of pre-initiation counseling were low. Rates of sperm cryopreservation, while improved in the counseled group remained low, suggesting prescribing physicians may be unaware of this option for patients.
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Affiliation(s)
- Lauren Folgosa Cooley
- Department of Urology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Arkes 23-015, Chicago, IL, 60611, USA
| | - James Wren
- Department of Urology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Arkes 23-015, Chicago, IL, 60611, USA
| | - Mary Kate Keeter
- Department of Urology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Arkes 23-015, Chicago, IL, 60611, USA
| | - Isaac Lam
- Department of Urology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Arkes 23-015, Chicago, IL, 60611, USA
| | - Nelson Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Arkes 23-015, Chicago, IL, 60611, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Arkes 23-015, Chicago, IL, 60611, USA.
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18
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Fertility and infertility implications in rheumatoid arthritis; state of the art. Inflamm Res 2020; 69:721-729. [PMID: 32458007 DOI: 10.1007/s00011-020-01362-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/28/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A bulk of investigations imply that women with rheumatoid arthritis (RA) deliver fewer children in comparison to healthy women. PURPOSE This review article attempts to clarify the involvement of infertility-related issues in both RA men and women. Moreover, the effect of RA disease on the fertility quality and quantity will be discussed. RESULTS Declined fertility rate in RA women seems to stem from modified inflammatory settings, advanced maternal age, limited sexual activity, and adverse effects of drugs on ovarian function. Women with RA may have smaller families and seem to be slower to conceive relative to their peer women. The chance of gestation in RA women may drop due to suppressed sexual function through pain and fatigue. In addition, treatment of RA women with non-steroidal anti-inflammatory drugs (NSAIDs) may prevent ovulation and therefore hinder the conception. CONCLUSIONS A complex interaction between RA disease and fertility related issues is present. Despite an increase rate of infertility in RA females or males, the mechanisms involved in this outcome is still unknown. Plausible causes of the decreased fertility rate in RA patients might be due to inflammatory cytokines, suppressed sexual activity, drug treatments, mother age, personal choice, or a combination of these elements.
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19
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Rosales Santillan M, Morss PC, Porter ML, Kimball AB. Biologic therapies for the treatment of hidradenitis suppurativa. Expert Opin Biol Ther 2020; 20:621-633. [PMID: 32077334 DOI: 10.1080/14712598.2020.1732918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Hidradenitis suppurativa (HS) is a chronic skin disorder characterized by inflammatory nodules, abscesses, and fistulae. Patients tend to present in young adulthood and are predominantly female. The pathogenesis of HS involves apopilosebaceous gland follicle occlusion and affected areas often occur where this type of gland predominates. Treatment selection depends on HS severity, which is included in different scoring systems. In recent years, biological therapies have been evaluated and used with increasing frequency in moderate-to-severe HS disease.Areas covered: This review focuses on biological therapies for HS as assessed in case reports, case series, and clinical trials. The efficacy, hidradenitis suppurativa scoring systems, and long-term results of these therapies are discussed depending on the studies' endpoints.Expert opinion: Adalimumab is currently the only FDA-approved HS biological therapy. Some patients do not experience treatment efficacy with adalimumab at 40 mg/week, which may result in increasing the dose or seeking other treatments. Infliximab is the next line of HS treatment with demonstrated efficacy. Other biological therapies being studied have demonstrated efficacy in small patient groups, but lack study power. Further studies may provide answers to seeking treatment options for patients who fail to improve on current standard HS treatment.
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Affiliation(s)
- Monica Rosales Santillan
- Harvard Medical School and Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Peyton C Morss
- Harvard Medical School and Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Medical School, University of Massachusetts, Worcester, MA, USA
| | - Martina L Porter
- Harvard Medical School and Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alexa B Kimball
- Harvard Medical School and Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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20
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Perez-Garcia LF, Te Winkel B, Carrizales JP, Bramer W, Vorstenbosch S, van Puijenbroek E, Hazes JMW, Dolhain RJEM. Sexual function and reproduction can be impaired in men with rheumatic diseases: A systematic review. Semin Arthritis Rheum 2020; 50:557-573. [PMID: 32165034 DOI: 10.1016/j.semarthrit.2020.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/14/2020] [Accepted: 02/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Information about the possible effect of rheumatic diseases on male sexual function and reproduction (sexual health) is scarce and difficult to summarize. Factors known to impair sexual health, such as inflammation, medication use and hypogonadism can be present in a significant proportion of male patients with rheumatic diseases. OBJECTIVES The objective of our study was to systematically review the literature for the influence of paternal rheumatic disease on sexual health, such as sexual function, reproductive hormones, male fertility, pregnancy and offspring outcomes. DATA SOURCES English language articles identified through Embase, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar and the Clinical trial registries of Europe and the USA published until February 2019. STUDY APPRAISAL AND SYNTHESIS METHODS Literature was synthesized in narrative form and in summary tables. Outcomes were categorized as: sexual function, reproductive hormones, fertility and pregnancy and offspring outcomes. Results are presented per category and per disease. RESULTS 9735 articles were identified with our search strategy. After removal of duplicates, excluding articles by screening titles and abstracts and assessing eligibility by reading 289 fulltext articles, 87 articles fulfilled the eligibility criteria. All included studies enrolled patients diagnosed with a rheumatic disease and had results at least on one of the outcome categories. Sexual function was the most common category, followed by reproductive hormones, fertility and pregnancy and offspring outcomes. Sexual function is impaired in a high proportion of patients with rheumatic diseases. This was statistically significant in most of the studies where a control group was available. Clinically relevant abnormalities in reproductive hormones were mainly identified in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) and a positive correlation with disease activity were reported. Semen quality in men with rheumatic diseases can be impaired in patients with SLE, SpA, sarcoidosis, BD and MWS. Sperm count and motility were the most common semen quality parameters affected. No negative effect of paternal RA and vasculitis on pregnancy outcomes were reported in 3 studies. No studies reporting the effect of paternal disease on offspring outcomes were identified. LIMITATIONS Most of the studies included in this review suffer from an inconsistent methodological quality, definitions of outcomes varied in several studies, a wide variety of screening questionnaires and/or diagnostic tools were used and results might only apply to the specific populations that were studied. CONCLUSIONS This systematic review suggests that sexual health is impaired in men with rheumatic diseases. The degree and extent of sexual health impairment vary per disease. More research is needed to fully understand the link between rheumatic diseases and impaired male sexual health. Meanwhile, rheumatologists should be aware of this association and discuss it with their patients. IMPLICATIONS OF KEY FINDINGS Sexual health of men with rheumatic diseases can be impaired by the disease itself. Especially in men trying to conceive, information on sexual function, reproductive hormones and sperm quality are needed to identify these problems. Treatment resulting in lower disease activity can improve overall sexual health in man with rheumatic diseases and facilitate their journey to fatherhood. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2018 CRD42018099845.
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Affiliation(s)
- L F Perez-Garcia
- Department of Rheumatology, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - B Te Winkel
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, the Netherlands
| | - J P Carrizales
- Servicio de Reumatología, Universidad Autónoma de Nuevo León, Hospital Universitario, Monterrey, Mexico
| | - W Bramer
- Medical Library, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - S Vorstenbosch
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, the Netherlands
| | - E van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, the Netherlands; PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen Research Institute of Pharmacy, Broerstraat 4, 9712 CP, Groningen, the Netherlands
| | - J M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - R J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
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Uyaroglu OA, Seyhoglu E, Erden A, Kilic L, Karadag O, Akdogan A, Bilgen SA, Ertenli AI, Kiraz S, Kalyoncu U. Pregnancy outcomes in partners of male ankylosing spondylitis patients treated with anti-tumour necrosis factor-α biologics: real-life results from a single-centre cross-sectional study. Rheumatol Int 2020; 40:1501-1507. [PMID: 31993731 DOI: 10.1007/s00296-020-04518-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
Most patients with inflammatory arthritis are at their reproductive ages. Use of anti-tumour necrosis factor alpha (anti-TNF-α) agents, one of the important treatment options for inflammatory arthritis, can cause foetal morbidity and mortality. While most studies on the effects of anti-TNF-α agents on pregnancy outcomes are about maternal exposure, the number of studies on the risks related to paternal exposure is insufficient. This study aimed to assess pregnancy periods and outcomes of the partners of male ankylosing spondylitis (AS) patients receiving anti-TNF-α treatment during the preconception period. Totally, 163 male AS patients using anti-TNF-α agents were identified from the Hacettepe University Biological Registry. Of these patients, 45 (27.6%) who declared that their partners got pregnant after initiation on anti-TNF-α agents were included. Data regarding demographics and drug exposure and pregnancy and infant outcomes were evaluated. Of 45 pregnancies, 39 (86.7%) resulted in healthy live births, 3 (6.7%) resulted in spontaneous abortion, and 3 (6.7%) were terminated with curettage. Of 39 live births, 34 (87.2%) were term and 5 (12.8%) were preterm, 30 (76.9%) had normal birth weight, 6 (15.4%) had low birth weight, and 3 (7.7%) had fetal macrosomia. No congenital malformations related to paternal exposure were observed. This study is valuable as being one of the studies providing pregnancy outcomes of partners of male AS patients receiving anti-TNF-α agents with its relatively high number of patients. The results suggested that paternal exposure to anti-TNF-α agents during preconception period could be safe on pregnancy outcomes.
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Affiliation(s)
- Oguz Abdullah Uyaroglu
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey.
| | - Emrah Seyhoglu
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey
| | - Abdulsamet Erden
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Levent Kilic
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Akdogan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sule Apras Bilgen
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Ihsan Ertenli
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sedat Kiraz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Umut Kalyoncu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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22
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Soh MC, Moretto M. The use of biologics for autoimmune rheumatic diseases in fertility and pregnancy. Obstet Med 2019; 13:5-13. [PMID: 32284726 DOI: 10.1177/1753495x19841799] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/10/2019] [Indexed: 12/18/2022] Open
Abstract
In an age where autoimmune rheumatic diseases are successfully managed with biologics, their discontinuation in pregnancy is inadvisable without careful forethought; maternal disease activity is associated with adverse pregnancy outcomes, which has long-term implications for both mother and offspring. We aim to provide clinicians with the necessary tools to facilitate decision-making - when a biologic should be used, when it can be discontinued in pregnancy if appropriate. The pathophysiology of these biologic molecules and their effect on fertility, pregnancy and parturition are discussed. A summary of the 2016 international guidelines (European League Against Rheumatism and British Society in Rheumatology) on biologics in pregnancy has been tabulated; more recent publications are discussed in depth. Data on transplacental-transfer ratios and breastmilk excretion rates are also included. Biologic effects on organogenesis, their implications for the exposed infant in terms of infection risks and vaccination requirements are included, and future directions for research proposed.
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Affiliation(s)
- May Ching Soh
- Department of Rheumatology, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand.,Department of Obstetrics and Gynaecology, Elizabeth Rothwell Building, Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand.,Women's Health Academic Centre, King's College London, London, UK
| | - Marcelo Moretto
- Department of Gynaecology, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,Clínica Generar-Human Reproduction, Porto Alegre, Brazil
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23
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Grosen A, Bungum M, Christensen LA, Cordelli E, Larsen OH, Leter G, Julsgaard M, Vestergaard T, Villani P, Hvas CL, Kelsen J. Semen Quality and Sperm DNA Integrity in Patients With Severe Active Inflammatory Bowel Disease and Effects of Tumour Necrosis Factor-alpha Inhibitors. J Crohns Colitis 2019; 13:564-571. [PMID: 30500868 DOI: 10.1093/ecco-jcc/jjy198] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The impact of severe inflammation on semen quality, including sperm DNA integrity, in men with inflammatory bowel disease [IBD] is unknown, as are the potential effects of anti-tumour necrosis factor-alpha [TNF-alpha] therapy. We investigated the influence of severe active IBD and anti-TNF-alpha treatment on semen quality. METHODS We prospectively included 20 patients admitted with severe active IBD. Further, 19 patients who initiated and 17 who stopped anti-TNF-alpha therapy were included. Semen samples were obtained during active disease, and on/off treatment. For paired comparisons, samples were collected not less than 3 months after achieving remission, after treatment initiation, or after treatment cessation. Sperm DNA Fragmentation Index [DFI], concentration, morphology, and motility were evaluated. Sex hormones and seminal plasma anti-TNF-alpha drug levels were measured. RESULTS In patients with severe disease, progressive sperm motility was impaired and increased significantly [from 28.4% to 37.4%, p = 0.045] during remission. There was no difference in DFI [12.5% versus 12.0%, p = 0.55], concentration [55.0 mill/ml versus 70.0 mill/ml, p = 0.39], or normal morphology [4.7% versus 5.1%, p = 0.51] in these patients. During active disease, testosterone was decreased, and normalised after obtaining remission. Patients who started anti-TNF-alpha therapy had a statistically significant, but clinically irrelevant, reduction in DFI after treatment initiation [12.8% versus 10.0%, p = 0.02]. All other semen parameters were unaffected by therapy. Anti-TNF-alpha drugs were excreted in negligible amounts in semen. CONCLUSIONS Severe active IBD reduces progressive sperm motility and testosterone levels, but sperm DNA integrity is unaffected by active disease. Anti-TNF-alpha therapy does not impair sperm quality.
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Affiliation(s)
- Anne Grosen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Mona Bungum
- Reproductive Medicine Centre, Skaane University Hospital, Malmoe, Sweden
| | - Lisbet Ambrosius Christensen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eugenia Cordelli
- Laboratory of Biosafety and Risk Assessment, ENEA, Casaccia Research Centre, Rome, Italy
| | - Ole Halfdan Larsen
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Giorgio Leter
- Laboratory of Biosafety and Risk Assessment, ENEA, Casaccia Research Centre, Rome, Italy
| | - Mette Julsgaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Thea Vestergaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Paola Villani
- Laboratory of Biosafety and Risk Assessment, ENEA, Casaccia Research Centre, Rome, Italy
| | - Christian Lodberg Hvas
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Kelsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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24
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Safety of anti-rheumatic drugs in men trying to conceive: A systematic review and analysis of published evidence. Semin Arthritis Rheum 2019; 48:911-920. [DOI: 10.1016/j.semarthrit.2018.07.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/18/2018] [Accepted: 07/23/2018] [Indexed: 12/31/2022]
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25
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Micu MC, Ostensen M, Bojincă V, Șerban O, Mihai M, Suța C, Ramazan A, Enache L, Bobircă A, Pătcaș SF, Micu R, Ionescu R. Pregnancy Outcomes in Couples with Males Exposed to Longterm Anti-tumor Necrosis Factor- α Inhibitor Therapies: A Prospective Study. J Rheumatol 2019; 46:1084-1088. [PMID: 30824658 DOI: 10.3899/jrheum.180588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the pregnancy achievement and outcomes in couples in which men with spondyloarthritis (SpA) were exposed to tumor necrosis factor inhibitors (TNFi). METHODS Information about pregnancies involving fathers with SpA was prospectively collected by 6 Romanian rheumatology centers. RESULTS Twenty-seven patients achieved 33 pregnancies and fathered 30 healthy children. Three elective abortions (personal reasons) and no spontaneous abortions, preeclampsia/eclampsia, stillbirths, congenital malformations, or pathologies in the children were recorded. Five patients showed normospermia before and after longterm TNFi treatment. CONCLUSION Pregnancy and child outcomes in male patients with SpA exposed to longterm TNFi therapy were reassuring.
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Affiliation(s)
- Mihaela C Micu
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Monika Ostensen
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Violeta Bojincă
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Oana Șerban
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Minodora Mihai
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Cristina Suța
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Anamaria Ramazan
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Luminița Enache
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Anca Bobircă
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Sergiu F Pătcaș
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Romeo Micu
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway. .,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report.
| | - Ruxandra Ionescu
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
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Paternal exposure to antirheumatic drugs—What physicians should know: Review of the literature. Semin Arthritis Rheum 2018; 48:343-355. [DOI: 10.1016/j.semarthrit.2018.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/19/2017] [Accepted: 01/09/2018] [Indexed: 12/11/2022]
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Pascarelli NA, Fioravanti A, Moretti E, Guidelli GM, Mazzi L, Collodel G. The effects in vitro of TNF-α and its antagonist 'etanercept' on ejaculated human sperm. Reprod Fertil Dev 2018; 29:1169-1177. [PMID: 27185240 DOI: 10.1071/rd16090] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 03/16/2016] [Indexed: 12/22/2022] Open
Abstract
Tumour necrosis factor (TNF)-α is primarily involved in the regulation of cell proliferation and apoptosis; in addition it possesses pro-inflammatory properties. Anti-TNF-α strategies involve either administration of anti-TNF-α antibody or soluble TNF receptor to mop up circulating TNF-α. Etanercept, a recombinant human TNF-α receptor, was found to be effective in the treatment of rheumatoid arthritis. The impact of TNF-α inhibitors on human fertility is of notable interest. This in vitro study investigated the effect of different concentrations of TNF-α and etanercept used alone or in combination on sperm viability, motility, mitochondrial function, percentage of apoptosis and chromatin integrity in swim-up selected human spermatozoa. A negative effect of TNF-α (300 and 500ng mL-1) and etanercept (from 800µg mL-1 to 2000µg mL-1) individually on sperm viability, motility, mitochondrial function, percentage of apoptotic spermatozoa and sperm DNA integrity was demonstrated. However, at concentrations of 100 and 200µg mL-1, etanercept can block, in a significant way, the toxic effects of TNF-α (500ng mL-1) on studied sperm characteristics. Our results confirm that TNF-α has a detrimental effect on sperm function and suggest, for the first time, that etanercept may counteract the in vitro toxic action of TNF-α. This data appears to be quite promising, although further studies, both in vivo and in vitro, are needed to understand the exact mechanism of action of TNF-α and TNF-α antagonists on sperm function.
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Affiliation(s)
- Nicola A Pascarelli
- Rheumatology Unit, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci, 14, 53100, Siena, Italy
| | - Antonella Fioravanti
- Rheumatology Unit, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci, 14, 53100, Siena, Italy
| | - Elena Moretti
- Department of Molecular and Developmental Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci, 14, 53100, Siena, Italy
| | - Giacomo M Guidelli
- Rheumatology Unit, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci, 14, 53100, Siena, Italy
| | - Lucia Mazzi
- Department of Molecular and Developmental Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci, 14, 53100, Siena, Italy
| | - Giulia Collodel
- Department of Molecular and Developmental Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci, 14, 53100, Siena, Italy
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Chatzimeletiou K, Galanis N, Karagiannidis A, Sioga A, Pados G, Goulis D, Kalpatsanidis A, Tarlatzis BC. Fertility potential in a man with ankylosing spondylitis as revealed by semen analysis by light, electron and fluorescence microscopy. SAGE Open Med Case Rep 2018; 6:2050313X18759898. [PMID: 29511542 PMCID: PMC5825999 DOI: 10.1177/2050313x18759898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/23/2018] [Indexed: 11/16/2022] Open
Abstract
Ankylosing spondylitis affects 0.1%–0.5% of the adult population. The aim was to investigate the possible effects of both the disease and its treatment on semen quality by performing a highly detailed analysis in a man with ankylosing spondylitis, presenting for infertility. Sperm characteristics were evaluated by light microscopy, morphology by electron microscopy (transmission electron microscopy), DNA fragmentation by terminal deoxynucleotidyl transferase dUTP nick end labeling using fluorescence microscopy and chromosomal abnormalities by fluorescence in situ hybridisation using probes for chromosomes 13,15,16,18,21,22,X and Y. There was no evidence for an effect of either ankylosing spondylitis or its treatment with celecoxib and sulphasalazine on sperm quality as all parameters including concentration, motility, DNA fragmentation and aneuploidy incidence were within normal limits. Transmission electron microscopy, however, revealed a high incidence of head, neck and tail abnormalities, as well as the presence of immature sperm and phagocytes. Hysteroscopic removal of an endometrial polyp enabled the achievement of a spontaneous pregnancy and the delivery of a healthy boy.
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Affiliation(s)
- Katerina Chatzimeletiou
- Unit for Human Reproduction, 1 Department of Obstetrics & Gynaecology, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikiforos Galanis
- Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Karagiannidis
- Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonia Sioga
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Pados
- Unit for Human Reproduction, 1 Department of Obstetrics & Gynaecology, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Goulis
- Unit for Human Reproduction, 1 Department of Obstetrics & Gynaecology, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonis Kalpatsanidis
- Unit for Human Reproduction, 1 Department of Obstetrics & Gynaecology, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Basil C Tarlatzis
- Unit for Human Reproduction, 1 Department of Obstetrics & Gynaecology, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Heppt F, Colsman A, Maronna A, Uslu U, Heppt MV, Kiesewetter F, Sticherling M. Influence of TNF-alpha inhibitors and fumaric acid esters on male fertility in psoriasis patients. J Eur Acad Dermatol Venereol 2017; 31:1860-1866. [PMID: 28557008 DOI: 10.1111/jdv.14364] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/19/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Is there any influence of a therapy with TNF-alpha inhibitors or fumaric acid esters and of disease activity status on male fertility and sperm quality in patients with psoriasis? METHODS In this monocentric, open-label, prospective study, semen samples were collected from patients receiving either TNF-alpha inhibitors or fumaric acid esters for moderate-to-severe plaque psoriasis. Semen was analysed at baseline before onset of the systemic therapy and monitored every 3 months under therapy. Sperm parameters were assessed according to the current WHO definitions. RESULTS In total, 101 semen specimens from 27 patients were obtained. Mean Psoriasis Area and Severity Index (PASI) score at baseline was 11.05. Only 14.8% of patients showed a normozoospermia without any other abnormal seminal values. 85.2% of patients had at least one sperm/seminal abnormality, including two patients showing an azoospermia. Interestingly, 48.1% showed sperm parameters indicative of genital tract inflammation. Therapy with TNF-alpha inhibitors or fumaric acid esters did not have any negative effects on relevant sperm parameters such as mean total sperm number, sperm concentration, total and progressive motility. No major gonadal dysfunction was observed in any patient. CONCLUSION At baseline, many patients with psoriasis showed abnormal semen/sperm parameters and remarkably elevated leukocytes and values of seminal polymorphonuclear elastase, indicating a genital tract inflammation. Thus, genital tract inflammation may represent an important comorbidity of psoriasis, little attention paid to so far. Regarding treatment with TNF-alpha inhibitors or fumaric acid esters, no major negative (side-) effects on sperm quality were observed.
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Affiliation(s)
- F Heppt
- Department of Dermatology, University Hospital of Erlangen, Erlangen, Germany
| | - A Colsman
- Department of Dermatology, University Hospital of Erlangen, Erlangen, Germany
| | - A Maronna
- Department of Dermatology, University Hospital of Erlangen, Erlangen, Germany
| | - U Uslu
- Department of Dermatology, University Hospital of Erlangen, Erlangen, Germany
| | - M V Heppt
- Department of Dermatology and Allergy, Munich University Hospital (LMU), Munich, Germany
| | - F Kiesewetter
- Department of Dermatology, University Hospital of Erlangen, Erlangen, Germany
| | - M Sticherling
- Department of Dermatology, University Hospital of Erlangen, Erlangen, Germany
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Abstract
BACKGROUND Data on fertility rates and medication safety in men with inflammatory bowel disease (IBD) are limited. The aim of this study was to evaluate whether there is a seminal alteration in patients with IBD and, if so, to evaluate the mechanisms that may play a role according to what has been described in the literature. Its secondary aim was to evaluate the impact on male sexual function of IBD. METHODS Multicenter, cross-sectional, case series study comparing men with IBD and control subjects. Semen analysis was performed according to the recommendations of World Health Organization. The impact on male sexual function was evaluated with the International Index of Erectile Function questionnaire. RESULTS On multivariate analysis, patients with Crohn's disease had lower sperm concentrations compared with those with ulcerative colitis (median [interquartile range], 34.5 [19.2-48] versus 70 [34.5-127.5], P = 0.02) and lower seminal zinc levels (mean ± SD, 1475 ± 235 μmol/L versus 2221 ± 1123 μmol/L, P = 0.04). Patients with Crohn's disease on anti-tumor necrosis factor treatment had better progressive motility (mean ± SD, 56.7 ± 17.7 versus 35.1 ± 22.1, P = 0.01) and sperm morphology (14.4 ± 7.1 versus 7.6 ± 4.9, P = 0.04) than those who were not on anti-tumor necrosis factor. Regarding sexual function, no significant differences were found across patients with IBD and control subjects. CONCLUSIONS Men with Crohn's disease showed a trend toward poorer semen quality than those with ulcerative colitis. Treatment with anti-tumor necrosis factor drugs does not seem to be associated with poor sperm quality. In patients in clinical remission, male sexual function is not affected by IBD.
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Semet M, Paci M, Saïas-Magnan J, Metzler-Guillemain C, Boissier R, Lejeune H, Perrin J. The impact of drugs on male fertility: a review. Andrology 2017. [PMID: 28622464 DOI: 10.1111/andr.12366] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Beside cytotoxic drugs, other drugs can impact men's fertility through various mechanisms. Via the modification of the hypothalamic-pituitary-gonadal axis hormones or by non-hormonal mechanisms, drugs may directly and indirectly induce sexual dysfunction and spermatogenesis impairment and alteration of epididymal maturation. This systematic literature review summarizes existing data about the negative impact and associations of pharmacological treatments on male fertility (excluding cytotoxic drugs), with a view to making these data more readily available for medical staff. In most cases, these effects on spermatogenesis/sperm maturation/sexual function are reversible after the discontinuation of the drug. When a reprotoxic treatment cannot be stopped and/or when the impact on semen parameters/sperm DNA is potentially irreversible (Sulfasalazine Azathioprine, Mycophenolate mofetil and Methotrexate), the cryopreservation of spermatozoa before treatment must be proposed. Deleterious impacts on fertility of drugs with very good or good level of evidence (Testosterone, Sulfasalazine, Anabolic steroids, Cyproterone acetate, Opioids, Tramadol, GhRH analogues and Sartan) are developed.
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Affiliation(s)
- M Semet
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France
| | - M Paci
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France.,Aix Marseille Univ, INSERM, GMGF UMR_S 910, Marseille, France
| | - J Saïas-Magnan
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France
| | - C Metzler-Guillemain
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France.,Aix Marseille Univ, INSERM, GMGF UMR_S 910, Marseille, France
| | - R Boissier
- Aix-Marseille University, Marseille, France.,Department of Urology and Renal Transplantation, APHM, Conception University Hospital, Marseille, France
| | - H Lejeune
- Service de Médecine de la Reproduction, Hôpital Femme Mère, Enfant, CHU de Lyon, Bron, France
| | - J Perrin
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France.,Aix Marseille Univ, Univ Avignon, CNRS, IRD, IMBE, Marseille, France
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Abstract
Fertility is impaired in women with rheumatoid arthritis (RA), whereas less is known about male fertility problems. Pregnancy outcome in patients with RA is slightly less favorable compared with the general population, especially in patients with active disease. Disease activity usually improves during pregnancy, but less than previously thought. Although several antirheumatic drugs are contraindicated in pregnancy, more treatment options are available. There is evidence on the safety of TNF inhibitors in pregnancy. Given the impact of active disease on fertility and pregnancy outcome, a treat-to-target strategy is recommended for patients who are pregnant or have a wish to conceive.
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Tumor Necrosis Factor-Alpha and Pregnancy: Focus on Biologics. An Updated and Comprehensive Review. Clin Rev Allergy Immunol 2017; 53:40-53. [DOI: 10.1007/s12016-016-8596-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Immunosuppressants and Male Reproduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1034:179-210. [PMID: 29256132 DOI: 10.1007/978-3-319-69535-8_12] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Prolonged use of immunosuppressant medications is occasionally seen in infertile men with chronic inflammatory conditions; autoimmune disorders; or an organ or hematopoietic stem cell transplant. Chronic inflammation impacts negatively on male reproductive endpoints, so immunosuppressant therapy can produce improvements. Corticosteroids have been used to treat antisperm antibodies and even as an empirical treatment for male infertility in general. Trials of these methods have provided mixed results on semen quality and fertility, with improvement, no change and negative effects reported by different investigators. In a substantial number of observational studies, patients on long-term therapy with prednisone for chronic inflammatory disease, testosterone levels were lower compared to untreated controls, though randomized controlled trials have not been conducted. Similarly decreases in testosterone have been reported in men receiving corticosteroids to minimize transplant rejection; however, most were treated with multiple immunosuppressive medications that may have contributed to this effect. A large number of trials of healthy men treated with corticosteroids have shown some disruption in reproductive hormone levels, but other studies reported no effect. Studies in monkeys, rats (at human equivalent dose), cattle, sheep, and horses have shown endocrine disruption, including low testosterone with dexamethasone treatment. Of the cytostatic immunosuppressives, which have high potential for cellular damage, cyclophosphamide has received the most attention, sometimes lowering sperm counts significantly. Methotrexate may decrease sperm numbers in humans and has significant negative impacts in rodents. Other chemotherapeutic drugs used as immunosuppressants are likely to impact negatively on male fertility endpoints, but few data have been collected. The TNF-α Inhibitors have also received little experimental attention. There is some evidence that the immunophilin modulators: cyclosporine, sirolimus, and everolimus cause endocrine disruption and semen quality impairment. As we review in this chapter, results in experimental species are concerning, and well-designed studies are lacking for the effects of these medications on reproductive endpoints in men.
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Loveland KL, Klein B, Pueschl D, Indumathy S, Bergmann M, Loveland BE, Hedger MP, Schuppe HC. Cytokines in Male Fertility and Reproductive Pathologies: Immunoregulation and Beyond. Front Endocrinol (Lausanne) 2017; 8:307. [PMID: 29250030 PMCID: PMC5715375 DOI: 10.3389/fendo.2017.00307] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/23/2017] [Indexed: 12/22/2022] Open
Abstract
Germline development in vivo is dependent on the environment formed by somatic cells and the differentiation cues they provide; hence, the impact of local factors is highly relevant to the production of sperm. Knowledge of how somatic and germline cells interact is central to achieving biomedical goals relating to restoring, preserving or restricting fertility in humans. This review discusses the growing understanding of how cytokines contribute to testicular function and maintenance of male reproductive health, and to the pathologies associated with their abnormal activity in this organ. Here we consider both cytokines that signal through JAKs and are regulated by SOCS, and those utilizing other pathways, such as the MAP kinases and SMADs. The importance of cytokines in the establishment and maintenance of the testis as an immune-privilege site are described. Current research relating to the involvement of immune cells in testis development and disease is highlighted. This includes new data relating to testicular cancer which reinforce the understanding that tumorigenic cells shape their microenvironment through cytokine actions. Clinical implications in pathologies relating to local inflammation and to immunotherapies are discussed.
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Affiliation(s)
- Kate L. Loveland
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, VIC, Australia
- Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
- *Correspondence: Kate L. Loveland,
| | - Britta Klein
- Institute of Veterinary Anatomy, Histology and Embryology, Justus Liebig University Giessen, Giessen, Germany
- Institute of Anatomy and Cell Biology, Justus Liebig University Giessen, Giessen, Germany
| | - Dana Pueschl
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, VIC, Australia
- Institute of Veterinary Anatomy, Histology and Embryology, Justus Liebig University Giessen, Giessen, Germany
| | - Sivanjah Indumathy
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, VIC, Australia
- Institute of Veterinary Anatomy, Histology and Embryology, Justus Liebig University Giessen, Giessen, Germany
| | - Martin Bergmann
- Institute of Veterinary Anatomy, Histology and Embryology, Justus Liebig University Giessen, Giessen, Germany
| | | | - Mark P. Hedger
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, VIC, Australia
| | - Hans-Christian Schuppe
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
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Birth Outcomes in Children Fathered by Men Treated with Anti-TNF-α Agents Before Conception. Am J Gastroenterol 2016; 111:1608-1613. [PMID: 27619836 DOI: 10.1038/ajg.2016.405] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/01/2016] [Accepted: 07/06/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The safety of paternal use of anti-tumor necrosis factor-α (TNF-α) agents immediately prior to conception is practically unknown. On the basis of nationwide data from Danish health registries, we examined the association between paternal use of anti-TNF-α agents within 3 months before conception and adverse birth outcomes. METHODS This nationwide cohort study is based on data from all women who had a live born singleton child in Denmark from 1 January 2007 through 2013. Children fathered by men treated with anti-TNF-α agents within three months before conception constituted the exposed cohort (N=372), and children fathered by men not treated before conception constituted the unexposed cohort (N=399,498). The outcomes were congenital abnormalities (CAs), preterm birth, and small for gestational age (SGA). We adjusted for multiple covariates, and considered paternal underlying disease and concomitant medication. RESULTS The adjusted risks of CAs and preterm birth were close to unity, and the adjusted odds ratio (OR) for SGA was 1.70 (95% confidence interval (CI): 0.94-3.09). Restricting our analysis to fathers with inflammatory bowel disease, we found no increased risk of CAs or SGA, and the adjusted OR for pretem birth was 1.42 (95% CI: 0.52-3.86). Restricting our analysis to fathers with rheumatologic/dermatological diseases, we found no increased risk of CAs or preterm birth, and the adjusted OR for SGA was 1.70 (95% CI: 0.74-3.89). CONCLUSIONS Our results are overall reassuring regarding the safety of paternal preconceptional use of anti-TNF-α agents. The result regarding SGA should, however, be interpreted with caution as we found an increased risk, although not significantly increased.
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Tratamiento de las gestantes con enfermedades reumáticas o autoinmunitarias sistémicas con fármacos inmunodepresores y biológicos. Med Clin (Barc) 2016; 147:352-360. [DOI: 10.1016/j.medcli.2016.05.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 05/12/2016] [Accepted: 05/12/2016] [Indexed: 12/16/2022]
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Kokoszko-Bilska A, Sobkiewicz S, Fichna J. Inflammatory bowel diseases and reproductive health. Pharmacol Rep 2016; 68:859-64. [DOI: 10.1016/j.pharep.2016.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/08/2016] [Accepted: 03/11/2016] [Indexed: 02/07/2023]
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Grunewald S, Jank A. New systemic agents in dermatology with respect to fertility, pregnancy, and lactation. J Dtsch Dermatol Ges 2015; 13:277-89; quiz 290. [PMID: 25819232 DOI: 10.1111/ddg.12596] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
With the increasing use of new, predominantly biologic drugs in dermatology, questions frequently arise in clinical practice as to their safety in women wishing to conceive as well as during pregnancy and lactation. Apart from the Summary of Product Characteristics and the Physician's Desk Reference, reliable information may be obtained from databases such as the one compiled by the Center for Pharmacovigilance and Consultation on Embryonal Toxicology at Charité University Medical Center Berlin (https://www.embryotox.de). Another source of information is researching recent publications, for example via PubMed (http://www.ncbi.nlm.nih.gov/pubmed). This article presents current knowledge from the sources mentioned above, and gives detailed information about the use of new biologic agents in women wishing to conceive as well as during pregnancy and lactation. Drugs reviewed include: infliximab, adalimumab, etanercept, metastatic for psoriasis, vemurafenib, dabrafenib, imatinib, ipilimumab for melanoma, vismodegib for basal cell carcinoma, rituximab for cutaneous lymphoma as well as omalizumab and anakinra used in the treatment of allergies.
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Affiliation(s)
- Sonja Grunewald
- Department of Dermatology, Venereology, and Allergology, University Hospital Leipzig
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Grunewald S, Paasch U. [Drug treatment of dermatological disorders. Aspects to consider from an andrological perspective]. Hautarzt 2015; 66:913-8. [PMID: 26452356 DOI: 10.1007/s00105-015-3706-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dermatologists administer a broad spectrum of systemic medications. However, our current knowledge of potential risks to male fertility is still limited, particularly with the new emerging therapies in dermato-oncology. Individual differences in susceptibility and a history of andrological disorders influence prognostic values. For fertility protection, a thoughtful selection of medication and/or sperm cryopreservation remain the best options.
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Affiliation(s)
- S Grunewald
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Ph.-Rosenthal-Str. 23, 04103, Leipzig, Deutschland.
| | - U Paasch
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Ph.-Rosenthal-Str. 23, 04103, Leipzig, Deutschland
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Abstract
Fertility is impaired in female patients with rheumatoid arthritis (RA), which is related to disease activity and the use of certain medication. During pregnancy, disease activity usually improves, but less than previously thought. Especially in women with high disease activity, the pregnancy outcome is also impaired. All of this underscores the importance of strict control of disease activity in RA patients who wish to conceive. Management of RA disease activity during pregnancy might be a challenge as the treatment options are limited. Evidence is accumulating that tumor necrosis factor (TNF) blockers can be safely used during pregnancy, particularly during the first trimester and the beginning of the second trimester. Far less is known about the problems faced by male RA patients who wish to conceive, in terms of not only fertility and pregnancy outcome but also the safety of medication. In this paper, the fertility issues in patients with RA, the pregnancy-associated improvement of RA, the pregnancy outcomes, including the long-term effects on the offspring, and treatment options, including those during lactation and for male patients wishing to conceive, will be reviewed.
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Affiliation(s)
- Hilal Ince-Askan
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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Bazzani C, Andreoli L, Agosti M, Nalli C, Tincani A. Antirheumatic drugs and reproduction in women and men with chronic arthritis. RMD Open 2015; 1:e000048. [PMID: 26557371 PMCID: PMC4632146 DOI: 10.1136/rmdopen-2015-000048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/26/2015] [Accepted: 05/01/2015] [Indexed: 12/23/2022] Open
Abstract
The impact of rheumatic disease on fertility and reproduction can be remarkable. Many disease-related factors can influence patients' sexual functioning, perturb fertility and limit family planning. Antirheumatic pharmacological treatment can also have a crucial role in this field. Proper counselling, preferably provided by a multidisciplinary team of rheumatologists, obstetricians, gynaecologists and neonatologists, is recommended for patients taking antirheumatic drugs, not only at the beginning, but also during the course of treatment. Paternal exposure to antirheumatic drugs was not found to be specifically associated with congenital malformation and adverse pregnancy outcome, therefore discontinuation of these drugs while planning for conception should be weighed against the risk of disease flare. Drugs in Food and Drug Administration (FDA) category 'X' should be withdrawn in a timely manner in women who desire a pregnancy. Meanwhile, disease control can be achieved with anti-tumour necrosis factor (TNF)-α agents, which are not teratogenic drugs. If maternal disease control is permissive, they can be stopped as soon as the pregnancy test turns positive and be resumed during pregnancy in case of a flare.
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Affiliation(s)
- Chiara Bazzani
- Rheumatology and Clinical Immunology Unit, Spedali Civili di Brescia, Brescia, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, Spedali Civili di Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Michele Agosti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology Unit, Spedali Civili di Brescia, Brescia, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Spedali Civili di Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Grunewald S, Jank A. Neue dermatologische Systemtherapien bei Kinderwunsch, Schwangerschaft und Stillzeit. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12596_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Sonja Grunewald
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR
| | - Alexander Jank
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig AöR
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Østensen M, Andreoli L, Brucato A, Cetin I, Chambers C, Clowse MEB, Costedoat-Chalumeau N, Cutolo M, Dolhain R, Fenstad MH, Förger F, Wahren-Herlenius M, Ruiz-Irastorza G, Koksvik H, Nelson-Piercy C, Shoenfeld Y, Tincani A, Villiger PM, Wallenius M, von Wolff M. State of the art: Reproduction and pregnancy in rheumatic diseases. Autoimmun Rev 2014; 14:376-86. [PMID: 25555818 DOI: 10.1016/j.autrev.2014.12.011] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/23/2014] [Indexed: 12/13/2022]
Abstract
Throughout the last decade, increasing awareness has been raised on issues related to reproduction in rheumatic diseases including basic research to clarify the important role of estrogens in the etiology and pathophysiology of immune/inflammatory diseases. Sub- or infertility is a heterogeneous condition that can be related to immunological mechanisms, to pregnancy loss, to disease burden, to therapy, and to choices in regard to family size. Progress in reproductive medicine has made it possible for more patients with rheumatic disease to have children. Active disease in women with rheumatoid arthritis (RA) affects their children's birth weight and may have long-term effects on their future health status. Pregnancy complications as preeclampsia and intrauterine growth restriction are still increased in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), however, biomarkers can monitor adverse events, and several new therapies may improve outcomes. Pregnancies in women with APS remain a challenge, and better therapies for the obstetric APS are needed. New prospective studies indicate improved outcomes for pregnancies in women with rare diseases like systemic sclerosis and vasculitis. TNF inhibitors hold promise for maintaining remission in rheumatological patients and may be continued at least in the first half of pregnancy. Pre-conceptional counseling and interdisciplinary management of pregnancies are essential for ensuring optimal pregnancy outcomes.
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Affiliation(s)
- Monika Østensen
- National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olavs Hospital, University Hospital of Trondheim, Norway.
| | - Laura Andreoli
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Antonio Brucato
- Department of Internal Medicine, Ospedale papa Giovanni XXIII Bergamo, Italy
| | - Irene Cetin
- Department of Mother and Child, Hospital Luigi Sacco, University of Milano, Italy
| | - Christina Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093-0828, USA
| | - Megan E B Clowse
- Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Nathalie Costedoat-Chalumeau
- Université Paris-Descartes, Paris, France; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Paris, France
| | - Maurizio Cutolo
- Research Laboratories and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Radboud Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M H Fenstad
- Department of Immunology and Transfusion Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Frauke Förger
- Department of Rheumatology and Clinical Immunology/Allergology, University Hospital of Bern, CH-3010 Bern, Switzerland
| | - Marie Wahren-Herlenius
- Department of Medicine, Centre for Molecular Medicine, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, Spain
| | - Hege Koksvik
- National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olavs Hospital, University Hospital of Trondheim, Norway
| | | | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Israel
| | - Angela Tincani
- Department of Rheumatology and Clinical Immunology, Ospedale Civile and University of Brescia, Brescia, Italy
| | - Peter M Villiger
- Department of Rheumatology and Clinical Immunology/Allergology, University Hospital of Bern, Bern, Switzerland
| | - Marianne Wallenius
- National Service for Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, Trondheim, Norway; Dept of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Michael von Wolff
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, University of Berne, Berne, Switzerland
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