For clinicians
Guideline comparison matrix
Antirheumatic drug compatibility across ACR 2020, EULAR 2024, and BSR 2022/23. Generated from the drug atoms; open a drug for detail and citations.
Positions use a non-categorical vocabulary. Rows marked divergence are where the three guidelines differ.
At a glance: compatibility by reproductive phase
| Drug | Pre-conception | 1st trimester | 2nd/3rd trimester | Breastfeeding | Paternal |
|---|---|---|---|---|---|
| Abatacept divergence | Use if needed | Use if needed | Use if needed | Continue | Continue |
| Anifrolumab | Individualise | Avoid | Avoid | Individualise | Individualise |
| Azathioprine | Continue | Continue | Continue | Continue | Continue |
| Belimumab divergence | Use if needed | Use if needed | Use if needed | Continue | Individualise |
| Colchicine | Continue | Continue | Continue | Continue | Continue |
| Cyclophosphamide divergence | Stop pre-conception | Avoid | Individualise | Avoid | Individualise |
| Cyclosporine | Continue | Continue | Continue | Continue | Continue |
| Glucocorticoids divergence | Use if needed | Use if needed | Use if needed | Continue | Continue |
| Hydroxychloroquine | Continue | Continue | Continue | Continue | Continue |
| IL-1 inhibitors divergence | Use if needed | Use if needed | Use if needed | Continue | Continue |
| IL-17 inhibitors divergence | Use if needed | Use if needed | Use if needed | Use if needed | Continue |
| IL-6 inhibitors divergence | Use if needed | Use if needed | Use if needed | Continue | Use if needed |
| JAK inhibitors divergence | Stop pre-conception | Avoid | Avoid | Avoid | Individualise |
| Leflunomide divergence | Stop pre-conception | Avoid | Avoid | Avoid | Continue |
| Low-dose aspirin divergence | Use if needed | Continue | Continue | Continue | Continue |
| Methotrexate divergence | Stop pre-conception | Avoid | Avoid | Avoid | Continue |
| Mycophenolate divergence | Stop pre-conception | Avoid | Avoid | Avoid | Continue |
| NSAIDs divergence | Use if needed | Use if needed | Avoid | Continue | Continue |
| Rituximab divergence | Use if needed | Use if needed | Avoid | Continue | Continue |
| Sulfasalazine divergence | Continue | Continue | Continue | Continue | Use if needed |
| Tacrolimus | Continue | Continue | Continue | Continue | Continue |
| TNF inhibitors divergence | Continue | Continue | Continue | Continue | Continue |
| Ustekinumab divergence | Use if needed | Use if needed | Use if needed | Continue | Continue |
Continue usually continued when needed Use if needed shared decision, less data Stop pre-conception generally stopped before conceiving Avoid generally avoided this phase
Position by guideline
| Drug | ACR 2020 | EULAR 2024 | BSR 2022/23 |
|---|---|---|---|
| Abatacept | Conditionally recommend discontinuing at conception; conditionally recommend AGAINST continuing during pregnancy (grouped with the other biologics: limited transfer in early pregnancy but high transfer in the second half). Breastfeeding: conditionally compatible, expecting minimal transfer from the large molecular size, though there are no data. Paternal: unable to make a recommendation (limited data). | May be used in pregnancy if needed to control maternal disease (4/C); compatible with lactation (4/C); continuable in men (4/C). | Consider stopping at conception; use in either trimester only for severe maternal disease if no other pregnancy-compatible drugs are suitable. Breastfeeding and paternal exposure compatible (limited evidence). If used in the third trimester, avoid infant live vaccinations until 6 months of age. |
| Anifrolumab | · | · | · |
| Azathioprine | Strongly recommend continuing before and during pregnancy (Table 3: ++/++); conditionally recommend during breastfeeding (+, low transfer). Paternal: strongly recommend continuing. | Compatible with pregnancy (2a/B) and lactation (2a/B); continuable in men (2b/B). | Compatible across peri-conception, both trimesters, breastfeeding, and paternal exposure. |
| Belimumab | Conditionally recommend discontinuing at conception; conditionally recommend AGAINST continuing during pregnancy (grouped with the other biologics: limited transfer in early pregnancy but high transfer in the second half). Breastfeeding: conditionally compatible, expecting minimal transfer from the large molecular size, though there are no data. Paternal: unable to make a recommendation (limited data). | May be used in pregnancy if needed to control maternal disease (4/C); compatible with lactation (4/C); limited data in men (5/D). | Consider stopping at conception; use in either trimester only for severe maternal disease if no other pregnancy-compatible drugs are suitable. Breastfeeding and paternal exposure compatible (limited evidence). If used in the third trimester, avoid infant live vaccinations until 6 months of age. |
| Colchicine | Strongly recommend continuing before pregnancy, during pregnancy, and in breastfeeding (Table 3: ++/++/++). Paternal: strongly recommend continuing. | Compatible with pregnancy (2b/B) and lactation (2a/B); continuable in men (2c/C). | Colchicine may be considered during pregnancy (GRADE 1B) and used in breastfeeding (GRADE 2C), based on a systematic review of 550 mostly-FMF pregnancies at 1-2 mg/day showing no significant increase in malformation or miscarriage. Paternal exposure unlikely to be harmful (limited data). |
| Cyclophosphamide | Strongly recommend against before pregnancy (stop 3 months prior to conception; address fertility preservation). During pregnancy: strongly against in the first trimester (teratogen), but conditionally recommended for life- or organ-threatening maternal disease in the second and third trimesters. Breastfeeding: strongly recommend against. Paternal: strongly recommend discontinuing 12 weeks (about 3 months) before attempting conception (impaired spermatogenesis and possible mutagenicity). | Teratogenic; discontinue before pregnancy (2a/B); may be considered only for severe maternal disease in the 2nd/3rd trimester (4/C). Avoid in lactation (4/D). In men: dose-related risk of irreversible infertility (2b/B), counsel on fertility preservation before starting. | Exceptional circumstances only (life- or organ-threatening maternal disease) at peri-conception and in both trimesters; NOT compatible with breastfeeding, and NOT compatible with paternal exposure. |
| Cyclosporine | Conditionally recommend cyclosporine (a calcineurin inhibitor) as compatible before and during pregnancy at the lowest effective dose, with blood-pressure monitoring. Breastfeeding: conditionally compatible (low transfer). Paternal: conditionally recommend continuing. | Compatible with pregnancy (2a/B) and lactation (2a/B); continuable in men (2b/B). | Compatible across peri-conception, both trimesters, breastfeeding, and paternal exposure; monitor maternal blood pressure, renal function, blood glucose, and drug levels in pregnancy. |
| Glucocorticoids | Conditionally recommend continuing low-dose non-fluorinated glucocorticoids (prednisone <=10 mg/day or equivalent) when clinically indicated. Strongly recommend tapering higher doses to <20 mg/day by adding a pregnancy-compatible steroid-sparing agent. Breastfeeding: compatible; after a dose >20 mg, delay breastfeeding for 4 hours. Delivery: conditionally against routine stress-dose steroids for vaginal delivery, conditionally recommend them for cesarean. ACR gives no paternal recommendation for glucocorticoids. | Prednisone/prednisolone can be used in pregnancy (2a/B); taper to a maintenance dose <=5 mg/day and withdraw where possible, weighing higher doses against maternal-foetal complications. Compatible with lactation (2a/B). Continuable in men (2b/B). | Prednisolone compatible across peri-conception, both trimesters, breastfeeding, and paternal exposure. |
| Hydroxychloroquine | Strongly recommend continuing hydroxychloroquine before pregnancy, during pregnancy, and in breastfeeding (Table 3: ++/++/++). If already taking it, strongly continue; if not, conditionally recommend starting when there is no contraindication. All women with SLE are advised to take it in pregnancy if possible. Paternal: strongly recommend continuing. | Compatible with pregnancy (LoE 2a/GoR B) and lactation (2a/B); continuable in male patients (2c/C). | Compatible (<=400 mg/day) at peri-conception, first trimester, second/third trimester, breastfeeding, and paternal exposure. |
| IL-1 inhibitors | For anakinra (the IL-1 inhibitor ACR addresses): conditionally recommend discontinuing at conception; conditionally recommend AGAINST during pregnancy (other-biologics group). Breastfeeding: conditionally compatible (minimal transfer expected, no data). Paternal: conditionally recommend continuing anakinra. ACR does not separately address canakinumab or rilonacept. | Anakinra and canakinumab may be used in pregnancy if needed (both 4/C); compatible with lactation (both 2a/B); continuable in men (both 4/C). | Consider stopping at conception; use in either trimester only for severe maternal disease if no other pregnancy-compatible drugs are suitable. Breastfeeding and paternal exposure compatible (limited evidence). If used in the third trimester, avoid infant live vaccinations until 6 months of age. |
| IL-17 inhibitors | Conditionally recommend discontinuing at conception; conditionally recommend AGAINST continuing during pregnancy (grouped with the other biologics: limited transfer in early pregnancy but high transfer in the second half). Breastfeeding: conditionally compatible, expecting minimal transfer from the large molecular size, though there are no data. Paternal: unable to make a recommendation (limited data). | Secukinumab and ixekizumab may be used in pregnancy if needed (both 4/C); limited lactation data (both 5/D) though minimal milk transfer is expected; continuable in men (both 4/C). | Consider stopping at conception; use in either trimester only for severe maternal disease if no other pregnancy-compatible drugs are suitable. Breastfeeding and paternal exposure compatible (limited evidence). If used in the third trimester, avoid infant live vaccinations until 6 months of age. |
| IL-6 inhibitors | Conditionally recommend discontinuing at conception; conditionally recommend AGAINST continuing during pregnancy (grouped with the other biologics: limited transfer in early pregnancy but high transfer in the second half). Breastfeeding: conditionally compatible, expecting minimal transfer from the large molecular size, though there are no data. Paternal: unable to make a recommendation (limited data). | Tocilizumab and sarilumab may be used in pregnancy if needed (both 4/C); lactation tocilizumab 4/C, sarilumab 4/C; in men tocilizumab 4/C, sarilumab 5/D. | Consider stopping at conception; use in either trimester only for severe maternal disease if no other pregnancy-compatible drugs are suitable. Breastfeeding and paternal exposure compatible (limited evidence). If used in the third trimester, avoid infant live vaccinations until 6 months of age. |
| JAK inhibitors | Unable to make a recommendation due to limited data (tofacitinib, baricitinib); the small molecular size suggests transfer across the placenta and into breast milk. Paternal: unable to make a recommendation. | Insufficient pregnancy data; avoid and switch to a compatible agent before conception (baricitinib 5/D, filgotinib 5/D, tofacitinib 4/C, upadacitinib 5/D). Avoid in lactation (5/D). In men, data are limited (tofacitinib 4/C; filgotinib shows no negative sperm-quality signal but very limited pregnancy data, 1/B-4/C; baricitinib and upadacitinib 5/D); consider switching. | Stop >=2 weeks pre-conception; not compatible in either trimester or with breastfeeding. Paternal exposure compatible (limited evidence). |
| Leflunomide | Strongly recommend against before and during pregnancy: perform a cholestyramine washout if levels are detectable pre-conception, and stop with cholestyramine washout during pregnancy. Breastfeeding: strongly recommend against. Paternal: conditionally recommend continuing. | Insufficient pregnancy data; discontinue 5 half-lives (~3.5 months) before pregnancy, or use accelerated elimination e.g. cholestyramine (2b/B). Avoid in lactation (5/D). Continuable in men (2c/C). | Not compatible peri-conception without cholestyramine washout; not compatible in either trimester or with breastfeeding. Compatible with paternal exposure. |
| Low-dose aspirin | Conditionally recommends low-dose aspirin 81 or 100 mg daily beginning in the first trimester in SLE; conditionally recommends prophylactic aspirin in aPL-positive pregnancy. | Low-dose aspirin for pre-eclampsia prophylaxis is not listed as an antirheumatic drug in the EULAR 2024 Table 1; this indication is an ACR 2020 recommendation. | Low-dose aspirin (<=150 mg/day) is recommended in all patients at high risk of pre-eclampsia (GRADE 1A) and may be continued throughout pregnancy until delivery (GRADE 1B); compatible with breastfeeding (GRADE 2C) and paternal exposure. |
| Methotrexate | Strongly recommend against before pregnancy (discontinue within 3 months prior to conception) and during pregnancy (stop; folic acid 5 mg/day) (Table 3: strongly against / strongly against). The narrative records that timing data are conflicting and do not permit a more specific recommendation, describing one menstrual cycle as the minimum and 3 months as the most common period, and notes that time off the drug also allows disease stability to be observed. Conditionally recommend against in breastfeeding (may accumulate in neonatal tissues despite minimal transfer into milk). Paternal: conditionally recommend continuing (data show no evidence of mutagenicity or teratogenicity). | Teratogenic; discontinue before pregnancy (2a/B). The narrative specifies discontinuation before conception at 1 to 3 months for methotrexate (1.5 months for mycophenolate, 3 months for cyclophosphamide); Table 1 does not restate the interval. In lactation, MTX <=25 mg/week may be considered only if no compatible alternative exists (4/C). Continuable in men at <=25 mg/week (2b/C). | Stop >=1 month pre-conception; not compatible in first or second/third trimester or with breastfeeding. Compatible with paternal exposure (<=25 mg/week). |
| Mycophenolate | Strongly recommend against before and during pregnancy and in breastfeeding (proven teratogen); stop >6 weeks before conception to confirm disease stability on a pregnancy-compatible agent. Paternal: conditionally recommend continuing. | Teratogenic; discontinue before pregnancy (2a/B). Avoid in lactation (5/D). Continuable in men (2b/C). | Stop >=6 weeks pre-conception; not compatible in either trimester or with breastfeeding. Compatible with paternal exposure. |
| NSAIDs | Conditionally recommend for the first and second trimesters, preferring nonselective NSAIDs over COX-2 inhibitors (limited COX-2 data); strongly recommend AGAINST in the third trimester (risk of premature closure of the ductus arteriosus). Conditionally recommend discontinuing pre-conception if there is difficulty conceiving (possible NSAID-induced unruptured follicle syndrome). Breastfeeding: ibuprofen preferred. Paternal: conditionally recommend continuing. | Nonselective NSAIDs may be used if needed to control disease (2a/B), only intermittently and stopped after 28 weeks of gestation; short half-life agents (ibuprofen) preferred; consider stopping if difficulty conceiving. Compatible with lactation (nonselective 2a/B; celecoxib 4/C). Continuable in men (2b/C). | Non-selective NSAIDs compatible peri-conception and, used intermittently, in the first trimester (possible small risk of miscarriage/malformation); wean from the end of the second trimester (26 weeks) and stop by gestational week 30 to avoid premature ductus arteriosus closure (GRADE 1B). Compatible with breastfeeding (ibuprofen preferred) and paternal exposure. COX-2 inhibitors avoided in pregnancy. |
| Rituximab | Conditionally recommend discontinuing at conception; during pregnancy conditionally reserved for life- or organ-threatening maternal disease. Breastfeeding: strongly recommend compatible. Paternal: conditionally recommend continuing. | May be used in pregnancy if needed to control maternal disease (4/C); compatible with lactation (2a/B); continuable in men (4/C). | Consider stopping at conception; in the first and second/third trimesters use only for severe maternal disease if no other pregnancy-compatible drugs are suitable. Breastfeeding and paternal exposure compatible (limited evidence). If used in the third trimester, avoid infant live vaccinations until 6 months of age. |
| Sulfasalazine | Strongly recommend continuing before pregnancy, during pregnancy, and in breastfeeding (Table 3: ++/++/++), with folic acid supplementation. Paternal: conditionally recommend continuing (may affect sperm count and quality; consider semen analysis if conception is delayed). | Compatible with pregnancy (2a/B) and lactation (2a/C); continuable in men (2b/C), with a possible reversible impact on sperm quality if conception is delayed. | Compatible throughout (with folic acid 5 mg/day in the first trimester); breastfeeding compatible in the healthy, full-term infant only; paternal compatible, though if conception is delayed beyond 12 months consider stopping alongside investigation of other causes of infertility. |
| Tacrolimus | Conditionally recommend tacrolimus (a calcineurin inhibitor) as compatible before and during pregnancy at the lowest effective dose, with blood-pressure monitoring. Breastfeeding: conditionally compatible (low transfer). Paternal: conditionally recommend continuing. | Compatible with pregnancy (2b/B) and lactation (2a/B); continuable in men (2b/B). | Compatible across peri-conception, both trimesters, breastfeeding, and paternal exposure; monitor maternal blood pressure, renal function, blood glucose, and drug levels in pregnancy. |
| TNF inhibitors | Conditionally recommend continuing infliximab, etanercept, adalimumab, and golimumab before and during pregnancy: continue through the first and second trimesters and discontinue in the third trimester several half-lives before delivery (Table 3: +/+). Strongly recommend continuing certolizumab before and throughout pregnancy (minimal placental transfer; Table 3: ++). Compatible with breastfeeding (++). Paternal: strongly recommend continuing all TNF inhibitors. | All TNF inhibitors can be used throughout pregnancy (2a/B) and are compatible with lactation (2a/B); continuable in men (1b/B). | All compatible at peri-conception and in the first trimester, and with breastfeeding and paternal exposure. In the second/third trimester, infant vaccination depends on the agent: if disease-flare risk is low and the drug is stopped by 20 weeks (infliximab), 28 weeks (adalimumab, golimumab), or 32 weeks (etanercept), a full-term infant can follow the normal vaccination schedule. Certolizumab is compatible throughout with no vaccination caveat. |
| Ustekinumab | Conditionally recommend discontinuing at conception; conditionally recommend AGAINST continuing during pregnancy (grouped with the other biologics: limited transfer in early pregnancy but high transfer in the second half). Breastfeeding: conditionally compatible, expecting minimal transfer from the large molecular size, though there are no data. Paternal: unable to make a recommendation (limited data). | May be used in pregnancy if needed (2b/B); compatible with lactation (2a/B); continuable in men (2b/C). | (IL-12/23 inhibitors row) Consider stopping at conception; use in either trimester only for severe maternal disease if no other pregnancy-compatible drugs are suitable. Breastfeeding and paternal exposure compatible (limited evidence). If used in the third trimester, avoid infant live vaccinations until 6 months of age. |
Where the guidelines diverge
=Abatacept. VERIFIED DIVERGENCE. EULAR 2024 (5b) permits use in pregnancy if needed to control maternal disease (4/C); BSR 2023 advises considering stopping at conception and reserving use for severe maternal disease when no alternative is suitable.
=Belimumab. VERIFIED DIVERGENCE. EULAR 2024 (5b) permits use in pregnancy if needed to control maternal disease (4/C); BSR 2023 advises considering stopping at conception and reserving use for severe maternal disease when no alternative is suitable. EULAR reports limited paternal data (5/D) whereas BSR marks paternal exposure compatible on limited evidence.
=Cyclophosphamide. VERIFIED DIVERGENCE (paternal). BSR 2023 Table 1 marks paternal cyclophosphamide exposure as NOT compatible. EULAR 2024 does not place cyclophosphamide on its continuable-in-men list either, but frames the male issue as a dose-related risk of irreversible infertility (2b/B) requiring fertility-preservation counselling before starting, rather than a prohibition on conceiving. Both agree it is teratogenic and reserved for life- or organ-threatening maternal disease.
=Glucocorticoids. VERIFIED DIVERGENCE (emphasis). BSR 2023 marks prednisolone compatible across all five phases. EULAR 2024 permits prednisone/prednisolone in pregnancy (2a/B) but adds an explicit dose ceiling: taper where possible to a maintenance dose of <=5 mg/day and withdraw when possible, weighing higher doses against maternal-foetal complications. EULAR's stance is more restrictive on dose than BSR's binary compatibility grid conveys.
=IL-1 inhibitors. VERIFIED DIVERGENCE. EULAR 2024 (5b) permits anakinra and canakinumab in pregnancy if needed (both 4/C) and considers both compatible with breastfeeding (2a/B); BSR 2023 advises considering stopping at conception and reserving use for severe maternal disease when no alternative is suitable.
=IL-17 inhibitors. VERIFIED DIVERGENCE. EULAR 2024 (5b) permits secukinumab and ixekizumab in pregnancy if needed (both 4/C) and considers them continuable in men (4/C); BSR 2023 advises considering stopping at conception and reserving use for severe maternal disease. On lactation EULAR grades the IL-17 inhibitors 5/D (limited data) while BSR marks breastfeeding compatible on limited evidence.
=IL-6 inhibitors. VERIFIED DIVERGENCE. EULAR 2024 (5b) permits tocilizumab and sarilumab in pregnancy if needed to control maternal disease (both 4/C); BSR 2023 advises considering stopping at conception and reserving use for severe maternal disease when no alternative is suitable.
=JAK inhibitors. VERIFIED DIVERGENCE (washout and paternal). BSR 2023 specifies stopping JAK inhibitors >=2 weeks pre-conception and marks paternal exposure compatible on limited evidence. EULAR 2024 lists them under insufficient pregnancy data (avoid until further evidence; baricitinib/filgotinib/upadacitinib 5/D, tofacitinib 4/C) and advises considering a switch in men trying to conceive, noting filgotinib shows no negative sperm-quality signal but very limited pregnancy-outcome data. Both avoid them in pregnancy and lactation.
=Leflunomide. VERIFIED DIVERGENCE (washout detail). EULAR 2024 lists leflunomide under insufficient pregnancy data and specifies discontinuing 5 half-lives (about 3.5 months) before pregnancy OR using accelerated elimination such as cholestyramine (2b/B). BSR 2023 requires cholestyramine washout at peri-conception. Both consider paternal exposure compatible and both avoid it in lactation.
=Low-dose aspirin. VERIFIED (direction agrees, dose ceiling differs). ACR 2020: conditionally recommends low-dose aspirin 81 or 100 mg daily from the first trimester in SLE and aPL-positive pregnancy. BSR 2023: <=150 mg/day for all at high pre-eclampsia risk, continued to delivery. EULAR 2024 does not list aspirin in its antirheumatic drug table. Both stated ceilings sit within the low-dose range.
=Methotrexate. VERIFIED DIVERGENCE (pre-conception interval). The three guidelines give three different intervals and must not be presented as one blended range. ACR 2020 strongly recommends discontinuation within 3 months prior to conception. EULAR 2024 specifies 1 to 3 months in its narrative, though Table 1 does not restate the interval. BSR 2023 gives at least 1 month (GRADE 1A, SOA 98%) and records 3 months as its own previous recommendation, citing the 2006 Ostensen consensus. All three read at source 2026-08-03. VERIFIED DIVERGENCE (lactation). ACR 2020 conditionally recommends against methotrexate while breastfeeding, citing possible accumulation in neonatal tissues despite minimal transfer into milk. BSR 2023 states it cannot be recommended (GRADE 2C, SOA 99%). EULAR 2024 places methotrexate <=25 mg/week among agents with limited lactation data that may be considered only where no compatible alternative can be used (4/C), a position its task force reached after extended discussion and lists as a research priority. The breastfeeding phase row follows ACR and BSR and reads avoid. Phase rows on this site are otherwise EULAR-driven, so this row is a deliberate departure, directed 2026-08-03. VERIFIED DIVERGENCE (paternal exposure). All three guidelines permit continuation of low-dose methotrexate (<=25 mg/week) in men trying to conceive: ACR 2020 conditionally, EULAR 2024 at 2b/C, BSR 2023 at GRADE 1B (SOA 99.3%). This remains at odds with some drug labels and agencies advising a 3 to 6 month stop.
=Mycophenolate. VERIFIED DIVERGENCE (pre-conception interval). BSR 2023 specifies stopping mycophenolate >=6 weeks pre-conception; EULAR 2024 states it is teratogenic and must be discontinued before pregnancy (2a/B) without naming a fixed interval in Table 1. Both consider paternal exposure compatible (EULAR 2b/C; BSR yes). EULAR additionally permits mycophenolate in the second/third trimester for severe refractory maternal disease (4/D); BSR marks both trimesters not compatible.
=NSAIDs. VERIFIED DIVERGENCE (gestational stop-week). Three sources give three thresholds for stopping non-selective NSAIDs: EULAR 2024 stops after 28 weeks; BSR 2023 weans from 26 weeks and stops by week 30; and the US FDA (2020, cited by BSR) advises avoiding from 20 weeks. All agree on third-trimester avoidance and the mechanism (premature ductus arteriosus constriction, oligohydramnios). Both EULAR and BSR prefer short half-life non-selective agents (ibuprofen) and both avoid COX-2 inhibitors in pregnancy.
=Rituximab. VERIFIED DIVERGENCE. EULAR 2024 (5b) states rituximab may be used in pregnancy if needed to effectively control maternal disease (4/C). BSR 2023 is more restrictive: consider stopping at conception, and use in either trimester only for severe maternal disease when no other pregnancy-compatible drug is suitable. Both agree it is compatible with breastfeeding, and both advise delaying infant live vaccines to 6 months after third-trimester exposure.
=Sulfasalazine. VERIFIED DIVERGENCE (detail, not direction). Both consider sulfasalazine compatible throughout pregnancy, lactation, and paternal exposure. BSR 2023 adds two specifics EULAR does not: folic acid 5 mg/day in the first trimester, and breastfeeding compatibility in the healthy full-term infant only. Both note a possible reversible impact on sperm quality, BSR advising consideration of stopping if conception is delayed beyond 12 months, EULAR framing it as delayed conception generally.
=TNF inhibitors. VERIFIED DIVERGENCE (infant vaccination thresholds). EULAR 2024 states rotavirus may be given on schedule after any in utero TNFi exposure, and that BCG should be delayed 6 months after second-half exposure to transferring agents (adalimumab, golimumab, infliximab after GW20; etanercept after GW32). BSR 2023 frames this by stopping thresholds for a normal infant schedule: infliximab by 20 weeks, adalimumab and golimumab by 28 weeks, etanercept by 32 weeks. The adalimumab/golimumab week differs between the two (GW20 vs 28 weeks). Both agree certolizumab requires no change. Both permit TNFi across pregnancy and breastfeeding.
=Ustekinumab. VERIFIED DIVERGENCE. EULAR 2024 (5b) permits ustekinumab in pregnancy if needed and grades it better than the other non-TNFi biologics (2b/B pregnancy, 2a/B lactation); BSR 2023 groups it with the other non-TNFi biologics (IL-12/23 row): consider stopping at conception, reserve for severe maternal disease when no alternative is suitable.