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摘要: 脊柱关节炎(spondyloarthritis, SpA)是一组以中轴骨和/或外周关节受累为主的慢性炎症性、致残性风湿免疫病, 严重影响患者的身体功能和生活质量。随着靶向药物的临床应用越来越多, 其精准且规范应用成为目前关注的重点。遵循共识制订的国际规范, 国家皮肤与免疫疾病临床医学研究中心制定了我国首部《脊柱关节炎靶向药物治疗专家共识》, 该共识对13个靶向药物应用过程中的重点问题作出推荐, 涵盖了靶向药物治疗SpA的原则、适用人群、用药前筛查、用药时机、药物选择和转换、合并用药、不良反应监测等, 并对特殊人群的用药注意事项提出建议, 对临床实践具有重要指导意义。Abstract: Spondyloarthritis (SpA) is a group of chronic inflammatory diseases which predominantly involve spine and/or peripheral joints. SpA can be disabling and seriously affect the quality of life and function of patients. With the increasing clinical use of targeted drug therapy, precise and standardized use becomes the focus. China's first Consensus on Targeted Drug Therapy for Spondyloarthritis was developed by National Clinical Research Center for Dermatologic and Immunologic Diseases using international norms for consensus development. The consensus addresses 13 important clinical questions, ranging from principles, patient eligibility, pre-treatment screening, treatment initiation, drug selection and switch, co-medication, to adverse event monitoring of targeted drug therapy in SpA, and recommends treatment for specific patients, playing a key role in guiding clinical practices.
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Key words:
- spondyloarthritis /
- targeted drug therapy /
- consensus /
- interpretation
作者贡献：杨晓曦、田新平、李梦涛、冷晓梅、赵岩负责文献查阅、资料收集及论文撰写；曾小峰负责选题组织及论文审校。利益冲突：所有作者均声明不存在利益冲突 -
表 1 脊柱关节炎患者围术期靶向药物应用建议
Table 1. Recommendations for perioperative targeted drug application in patients with spondyloarthritis
药物名称 用药间隔 推荐手术时间(自最后一次用药后) 英夫利昔单抗 每4周或每6周或每8周 第5周或第7周或第9周 阿巴西普 每月(静脉注射)或每周(皮下注射) 第5周(静脉注射)或第2周(皮下注射) 培塞利珠单抗 每2周或每4周 第3周或第5周 利妥昔单抗 每隔4~6个月用下一剂，两剂间隔2周 第5个月或第7个月 托珠单抗 每周(皮下注射)或每4周(静脉注射) 第2周(皮下注射)或第5周(静脉注射) 司库奇尤单抗 每4周 第5周 乌司奴单抗 每12周 第13周 依奇珠单抗 每4周 第5周 古塞奇尤单抗 每8周 第9周 托法替布 每日或每日2次 第4天 乌帕替尼 每日 第4天 
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表 2 脊柱关节炎患者不同妊娠阶段和哺乳期靶向药物应用建议
Table 2. Recommendations for targeted drug application in patients with spondyloarthritis during different stages of pregnancy and lactation
药物名称 围孕期 妊娠早期 妊娠中晚期 哺乳期 英夫利昔单抗 可用 可用 妊娠20周停药 可用，但证据不足 依那西普 可用 可用 孕早期、中期可用；孕晚期停药 可用，但证据不足 阿达木单抗 可用 可用 孕早期、中期可用；孕晚期停药 可用，但证据不足 培塞利珠单抗 可用 可用 可用，但证据不足 可用，但证据不足 戈利木单抗 无数据 无数据 无数据 无数据 乌司奴单抗 可用，但证据不足 无数据 无数据 无数据 司库奇尤单抗 可用，但证据不足 可用，但证据不足 无数据 无数据 注：参考英国风湿病学会和英国风湿病卫生专业人员协会关于肿瘤坏死因子抑制剂的处方处理意见[66]
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[1] Ng S C, Liao Z T, Yu D T T, et al. Epidemiology of spondyloarthritis in the People's Republic of China: review of the literature and commentary[J]. Semin Arthritis Rheum, 2007, 37(1): 39-47. doi: 10.1016/j.semarthrit.2007.01.003 [2] 国家皮肤与免疫疾病临床医学研究中心(北京协和医院), 中国医师协会风湿免疫专科医师分会, 中国康复医学会风湿免疫专业委员会, 等. 脊柱关节炎靶向药物治疗专家共识[J]. 中华内科杂志, 2023, 62(6): 606-618. National Clinical Research Center for Dermatologic and Immunologic Diseases (Peking Union Medical College Hospital), Rheumatology and Immunology Physicians Committee, Chinese Medical Doctors Association, Rheumatology and Immunology Professional Committee, Chinese Association of Rehabilitation Medicine, et al. Consensus on targeted drug therapy for spondyloarthritis[J]. Chin J Inter Med, 2023, 62(6): 606-618. [3] Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update[J]. Ann Rheum Dis, 2023, 82(1): 19-34. doi: 10.1136/ard-2022-223296 [4] Ward M M, Deodhar A, Gensler L S, et al. 2019 Update of the American College of Rheumatology/Spondylitis Associa-tion of America/spondyloarthritis research and treatment network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis[J]. Arthritis Rheumatol, 2019, 71(10): 1599-1613. doi: 10.1002/art.41042 [5] Van Der Heijde D, Baraf H S B, Ramos-Remus C, et al. Evaluation of the efficacy of etoricoxib in ankylosing spondylitis: results of a fifty-two-week, randomized, controlled study[J]. Arthritis Rheum, 2005, 52(4): 1205-1215. doi: 10.1002/art.20985 [6] Wanders A, Van Der Heijde D, Landewé R, et al. Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial[J]. Arthritis Rheum, 2005, 52(6): 1756-1765. doi: 10.1002/art.21054 [7] Clegg D O, Reda D J, Weisman M H, et al. Comparison of sulfasalazine and placebo in the treatment of ankylosing spondylitis. A department of veterans affairs cooperative study[J]. Arthritis Rheum, 1996, 39(12): 2004-2012. doi: 10.1002/art.1780391209 [8] Gonzalez-Lopez L, Garcia-Gonzalez A, Vazquez-Del-Mercado M, et al. Efficacy of methotrexate in ankylosing spondylitis: a randomized, double blind, placebo controlled trial[J]. J Rheumatol, 2004, 31(8): 1568-1574. [9] Gossec L, Baraliakos X, Kerschbaumer A, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update[J]. Ann Rheum Dis, 2020, 79(6): 700-712. [10] 中华医学会皮肤性病学分会, 中国医师协会皮肤科医师分会, 中国中西医结合学会皮肤性病专业委员会. 中国银屑病生物制剂治疗指南(2021)[J]. 中华皮肤科杂志, 2021, 54(12): 1033-1047. Dermatology and Venereology Branch of the Chinese Medical Association, Dermatologists Branch of the Chinese Medical Association, Dermatology & Venereology Specialized Committee of Chinese Association of Integrative Medicine. Guidelines for the treatment of psoriasis with biologic agents in China (2021)[J]. Chin J Dermat, 2021, 54(12): 1033-1047. [11] Machado P, Landewé R, Lie E, et al. Ankylosing spondylitis disease activity score (ASDAS): defining cut-off values for disease activity states and improvement scores[J]. Ann Rheum Dis, 2011, 70(1): 47-53. doi: 10.1136/ard.2010.138594 [12] Schett G, Lories R J, D'Agostino M A, et al. Enthesitis: from pathophysiology to treatment[J]. Nat Rev Rheumatol, 2017, 13(12): 731-741. doi: 10.1038/nrrheum.2017.188 [13] Rocha F A C, Pinto A C M D, Lopes J R, et al. Tumor necrosis factor inhibitors prevent structural damage in hips in ankylosing spondylitis-time to reconsider treatment guidelines? A case series and review of literature[J]. Clin Rheumatol, 2021, 40(5): 1881-1887. doi: 10.1007/s10067-020-05519-0 [14] Sepriano A, Kerschbaumer A, Bergstra S A, et al. Safety of synthetic and biological DMARDs: a systematic literature review informing the 2022 update of the EULAR recommendations for the management of rheumatoid arthritis[J]. Ann Rheum Dis, 2023, 82(1): 107-118. doi: 10.1136/ard-2022-223357 [15] Liu J, Zhang S K, Wang Q M, et al. Seroepidemiology of hepatitis B virus infection in 2 million men aged 21-49 years in rural China: a population-based, cross-sectional study[J]. Lancet Infect Dis, 2016, 16(1): 80-86. doi: 10.1016/S1473-3099(15)00218-2 [16] Perrillo R P, Gish R, Falck-Ytter Y T. American Gastroenterological Association Institute technical review on prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy[J]. Gastroenterology, 2015, 148(1): 221-244. e3. doi: 10.1053/j.gastro.2014.10.038 [17] Reddy K R, Beavers K L, Hammond S P, et al. American gastroenterological association institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy[J]. Gastroenterology, 2015, 148(1): 215-219. doi: 10.1053/j.gastro.2014.10.039 [18] Chen Y M, Huang W N, Wu Y D, et al. Reactivation of hepatitis B virus infection in patients with rheumatoid arthritis receiving tofacitinib: a real-world study[J]. Ann Rheum Dis, 2018, 77(5): 780-782. doi: 10.1136/annrheumdis-2017-211322 [19] Akiyama S, Cotter T G, Sakuraba A. Risk of hepatitis B virus reactivation in patients with autoimmune diseases undergoing non-tumor necrosis factor-targeted biologics[J]. World J Gastroenterol, 2021, 27(19): 2312-2324. doi: 10.3748/wjg.v27.i19.2312 [20] 黄安芳, 罗妍, 赵毅, 等. 风湿病患者合并潜伏性结核感染的分析[J]. 中华内科杂志, 2016, 55(4): 307-310. doi: 10.3760/cma.j.issn.0578-1426.2016.04.012 Huang A F, Luo Y, Zhao Y, et al. An analysis of latent tuberculosis infection among patients with rheumatic diseases[J]. Chin J Inter Med, 2016, 55(4): 307-310. doi: 10.3760/cma.j.issn.0578-1426.2016.04.012 [21] Minozzi S, Bonovas S, Lytras T, et al. Risk of infections using anti-TNF agents in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: a systematic review and meta-analysis[J]. Expert Opin Drug Saf, 2016, 15(sup1): 11-34. doi: 10.1080/14740338.2016.1240783 [22] Alves C, Penedones A, Mendes D, et al. The risk of infections associated with JAK inhibitors in rheumatoid arthritis: a systematic review and network meta-analysis[J]. J Clin Rheumatol, 2022, 28(2): e407-e414. doi: 10.1097/RHU.0000000000001749 [23] Thatiparthi A, Martin A, Liu J, et al. Biologic treatment algorithms for moderate-to-severe psoriasis with comorbid conditions and special populations: a review[J]. Am J Clin Dermatol, 2021, 22(4): 425-442. doi: 10.1007/s40257-021-00603-w [24] Mease P J, Gladman D D, Ritchlin C T, et al. Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial[J]. Arthritis Rheum, 2005, 52(10): 3279-3289. doi: 10.1002/art.21306 [25] Kavanaugh A, McInnes I B, Krueger G G, et al. Patient-reported outcomes and the association with clinical response in patients with active psoriatic arthritis treated with golimumab: findings through 2 years of a phase Ⅲ, multicenter, randomized, double-blind, placebo-controlled trial[J]. Arthritis Care Res (Hoboken), 2013, 65(10): 1666-1673. doi: 10.1002/acr.22044 [26] Mease P J, Fleischmann R, Deodhar A A, et al. Effect of certolizumab pegol on signs and symptoms in patients with psoriatic arthritis: 24-week results of a phase 3 double-blind randomised placebo-controlled study (RAPID-PsA)[J]. Ann Rheum Dis, 2014, 73(1): 48-55. doi: 10.1136/annrheumdis-2013-203696 [27] Antoni C, Krueger G G, de Vlam K, et al. Infliximab improves signs and symptoms of psoriatic arthritis: results of the IMPACT 2 trial[J]. Ann Rheum Dis, 2005, 64(8): 1150-1157. doi: 10.1136/ard.2004.032268 [28] McInnes I B, Mease P J, Kirkham B, et al. Secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis (FUTURE 2): a randomised, double-blind, placebo-controlled, phase 3 trial[J]. Lancet, 2015, 386(9999): 1137-1146. doi: 10.1016/S0140-6736(15)61134-5 [29] Nash P, Coates L C, Kivitz A J, et al. Safety and efficacy of tofacitinib in patients with active psoriatic arthritis: interim analysis of OPAL balance, an open-label, long-term extension study[J]. Rheumatol Ther, 2020, 7(3): 553-580. doi: 10.1007/s40744-020-00209-4 [30] McInnes I B, Kato K, Magrey M, et al. Upadacitinib in patients with psoriatic arthritis and an inadequate response to non-biological therapy: 56-week data from the phase 3 SELECT-PsA 1 study[J]. RMD Open, 2021, 7(3): e001838. doi: 10.1136/rmdopen-2021-001838 [31] Mease P J, Lertratanakul A, Papp K A, et al. Upadacitinib in patients with psoriatic arthritis and inadequate response to biologics: 56-week data from the randomized controlled phase 3 SELECT-PsA 2 study[J]. Rheumatol Ther, 2021, 8(2): 903-919. doi: 10.1007/s40744-021-00305-z [32] Kavanaugh A, Puig L, Gottlieb A B, et al. Maintenance of clinical efficacy and radiographic benefit through two years of ustekinumab therapy in patients with active psoriatic arthritis: results from a randomized, placebo-controlled phase Ⅲ trial[J]. Arthritis Care Res (Hoboken), 2015, 67(12): 1739-1749. doi: 10.1002/acr.22645 [33] Deodhar A, Helliwell P S, Boehncke W H, et al. Guselkumab in patients with active psoriatic arthritis who were biologic-naive or had previously received TNFα inhibitor treatment (DISCOVER-1): a double-blind, randomised, placebo-controlled phase 3 trial[J]. Lancet, 2020, 395(10230): 1115-1125. doi: 10.1016/S0140-6736(20)30265-8 [34] Mease P J, Gottlieb A B, Van Der Heijde D, et al. Efficacy and safety of abatacept, a T-cell modulator, in a randomised, double-blind, placebo-controlled, phase Ⅲ study in psoriatic arthritis[J]. Ann Rheum Dis, 2017, 76(9): 1550-1558. doi: 10.1136/annrheumdis-2016-210724 [35] Edwards C J, Blanco F J, Crowley J, et al. Apremilast, an oral phosphodiesterase 4 inhibitor, in patients with psoriatic arthritis and current skin involvement: a phase Ⅲ, randomised, controlled trial (Palace 3)[J]. Ann Rheum Dis, 2016, 75(6): 1065-1073. doi: 10.1136/annrheumdis-2015-207963 [36] McInnes I B, Behrens F, Mease P J, et al. Secukinumab versus adalimumab for treatment of active psoriatic arthritis (EXCEED): a double-blind, parallel-group, randomised, active-controlled, phase 3b trial[J]. Lancet, 2020, 395(10235): 1496-1505. doi: 10.1016/S0140-6736(20)30564-X [37] Mease P J, Smolen J S, Behrens F, et al. A head-to-head comparison of the efficacy and safety of ixekizumab and adalimumab in biological-naïve patients with active psoriatic arthritis: 24-week results of a randomised, open-label, blinded-assessor trial[J]. Ann Rheum Dis, 2020, 79(1): 123-131. doi: 10.1136/annrheumdis-2019-215386 [38] Nash P, Kirkham B, Okada M, et al. Ixekizumab for the treatment of patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors: results from the 24-week randomised, double-blind, placebo-controlled period of the SPIRIT-P2 phase 3 trial[J]. Lancet, 2017, 389(10086): 2317-2327. doi: 10.1016/S0140-6736(17)31429-0 [39] Reich K, Sullivan J, Arenberger P, et al. Secukinumab shows high and sustained efficacy in nail psoriasis: 2.5-year results from the randomized placebo-controlled TRANSFIGURE study[J]. Br J Dermatol, 2021, 184(3): 425-436. doi: 10.1111/bjd.19262 [40] Coates L C, Wallman J K, McGonagle D, et al. Secukinu-mab efficacy on resolution of enthesitis in psoriatic arthritis: pooled analysis of two phase 3 studies[J]. Arthritis Res Ther, 2019, 21(1): 266. doi: 10.1186/s13075-019-2055-z [41] Vieira-Sousa E, Alves P, Rodrigues A M, et al. GO-DACT: a phase 3b randomised, double-blind, placebo-controlled trial of GOlimumab plus methotrexate (MTX) versus placebo plus MTX in improving DACTylitis in MTX-naive patients with psoriatic arthritis[J]. Ann Rheum Dis, 2020, 79(4): 490-498. doi: 10.1136/annrheumdis-2019-216500 [42] Gladman D D, Orbai A M, Klitz U, et al. Ixekizumab and complete resolution of enthesitis and dactylitis: integrated analysis of two phase 3 randomized trials in psoriatic arthritis[J]. Arthritis Res Ther, 2019, 21(1): 38. doi: 10.1186/s13075-019-1831-0 [43] McGonagle D, McInnes I B, Deodhar A, et al. Resolution of enthesitis by guselkumab and relationships to disease burden: 1-year results of two phase 3 psoriatic arthritis studies[J]. Rheumatology (Oxford), 2021, 60(11): 5337-5350. doi: 10.1093/rheumatology/keab285 [44] Singh J A, Guyatt G, Ogdie A, et al. Special article: 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis[J]. Arthritis Care Res (Hoboken), 2019, 71(1): 2-29. doi: 10.1002/acr.23789 [45] Robinson P C, Van Der Linden S, Khan M A, et al. Axial spondyloarthritis: concept, construct, classification and implications for therapy[J]. Nat Rev Rheumatol, 2021, 17(2): 109-118. doi: 10.1038/s41584-020-00552-4 [46] Van Der Horst-Bruinsma I, Van Bentum R, Verbraak F D, et al. The impact of certolizumab pegol treatment on the incidence of anterior uveitis flares in patients with axial spondyloarthritis: 48-week interim results from C-VIEW[J]. RMD Open, 2020, 6(1): e001161. doi: 10.1136/rmdopen-2019-001161 [47] Van Bentum R E, Heslinga S C, Nurmohamed M T, et al. Reduced occurrence rate of acute anterior uveitis in ankylosing spondylitis treated with golimumab-the GO-EASY study[J]. J Rheumatol, 2019, 46(2): 153-159. doi: 10.3899/jrheum.180312 [48] Sandborn W J, Hanauer S B, Rutgeerts P, et al. Adalimumab for maintenance treatment of Crohn's disease: results of the CLASSIC Ⅱ trial[J]. Gut, 2007, 56(9): 1232-1239. doi: 10.1136/gut.2006.106781 [49] Sandborn W J, Feagan B G, Stoinov S, et al. Certolizumab pegol for the treatment of Crohn's disease[J]. N Engl J Med, 2007, 357(3): 228-238. doi: 10.1056/NEJMoa067594 [50] Adedokun O J, Xu Z H, Marano C W, et al. Pharmacokinetics and exposure-response relationship of golimumab in patients with moderately-to-severely active ulcerative colitis: results from phase 2/3 PURSUIT induction and maintenance studies[J]. J Crohns Colitis, 2017, 11(1): 35-46. doi: 10.1093/ecco-jcc/jjw133 [51] Deodhar A, Sliwinska-Stanczyk P, Xu H J, et al. Tofacitinib for the treatment of ankylosing spondylitis: a phase Ⅲ, randomised, double-blind, placebo-controlled study[J]. Ann Rheum Dis, 2021, 80(8): 1004-1013. doi: 10.1136/annrheumdis-2020-219601 [52] Van Der Heijde D, Song I H, Pangan A L, et al. Efficacy and safety of upadacitinib in patients with active ankylosing spondylitis (SELECT-AXIS 1): a multicentre, randomised, double-blind, placebo-controlled, phase 2/3 trial[J]. Lancet, 2019, 394(10214): 2108-2117. doi: 10.1016/S0140-6736(19)32534-6 [53] Deodhar A, Van Den Bosch F, Poddubnyy D, et al. Upadacitinib for the treatment of active non-radiographic axial spondyloarthritis (SELECT-AXIS 2): a randomised, double-blind, placebo-controlled, phase 3 trial[J]. Lancet, 2022, 400(10349): 369-379. doi: 10.1016/S0140-6736(22)01212-0 [54] Mulleman D, Lauféron F, Wendling D, et al. Infliximab in ankylosing spondylitis: alone or in combination with methotrexate? A pharmacokinetic comparative study[J]. Arthritis Res Ther, 2011, 13(3): R82. doi: 10.1186/ar3350 [55] Nissen M J, Ciurea A, Bernhard J, et al. The effect of comedication with a conventional synthetic disease-modifying antirheumatic drug on drug retention and clinical effectiveness of anti-tumor necrosis factor therapy in patients with axial spondyloarthritis[J]. Arthritis Rheumatol, 2016, 68(9): 2141-2150. doi: 10.1002/art.39691 [56] Ramiro S, Van Der Heijde D, Van Tubergen A, et al. Higher disease activity leads to more structural damage in the spine in ankylosing spondylitis: 12-year longitudinal data from the OASIS cohort[J]. Ann Rheum Dis, 2014, 73(8): 1455-1461. doi: 10.1136/annrheumdis-2014-205178 [57] Molto A, López-Medina C, Van Den Bosch F E, et al. Efficacy of a tight-control and treat-to-target strategy in axial spondyloarthritis: results of the open-label, pragmatic, cluster-randomised TICOSPA trial[J]. Ann Rheum Dis, 2021, 80(11): 1436-1444. doi: 10.1136/annrheumdis-2020-219585 [58] 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 中华传染病杂志, 2023, 41(1): 3-28. Chinese Society of Hepatology, Chinese Medical Association, Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B (2022 version)[J]. Chin J Infect Dis, 2023, 41(1): 3-28. [59] Sinagra E, Perricone G, Romano C, et al. Heart failure and anti tumor necrosis factor-alpha in systemic chronic inflammatory diseases[J]. Eur J Intern Med, 2013, 24(5): 385-392. doi: 10.1016/j.ejim.2012.12.015 [60] Sun W T, He Y H, Dong M M, et al. The comparative safety of biological treatment in patients with axial spondylarthritis: a meta-analysis of randomized controlled trials with placebo[J]. Eur Rev Med Pharmacol Sci, 2020, 24(19): 9824-9836. [61] Xie W H, Xiao S Y, Huang Y R, et al. A meta-analysis of biologic therapies on risk of new or recurrent cancer in patients with rheumatoid arthritis and a prior malignancy[J]. Rheumatology (Oxford), 2021, 60(5): 2495. doi: 10.1093/rheumatology/keaa871 [62] Winthrop K L, Cohen S B. Oral surveillance and JAK inhibitor safety: the theory of relativity[J]. Nat Rev Rheumatol, 2022, 18(5): 301-304. doi: 10.1038/s41584-022-00767-7 [63] Goodman S M, Springer B D, Chen A F, et al. 2022 American College of Rheumatology/American Association of Hip and Knee Surgeons guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty[J]. Arthritis Care Res (Hoboken), 2022, 74(9): 1399-1408. doi: 10.1002/acr.24893 [64] Clowse M E B, Scheuerle A E, Chambers C, et al. Pregnancy outcomes after exposure to certolizumab pegol: updated results from a pharmacovigilance safety database[J]. Arthritis Rheumatol, 2018, 70(9): 1399-1407. doi: 10.1002/art.40508 [65] Gisbert J P, Chaparro M. Safety of new biologics (vedolizumab and ustekinumab) and small molecules (tofacitinib) during pregnancy: a review[J]. Drugs, 2020, 80(11): 1085-1100. doi: 10.1007/s40265-020-01346-4 [66] Flint J, Panchal S, Hurrell A, et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids[J]. Rheumatology (Oxford), 2016, 55(9): 1693-1697. doi: 10.1093/rheumatology/kev404 -
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