Case Report: TNF-Alpha Inhibitors to Rescue Pregnancy in Women With Potential Pregnancy Loss: A Report of Ten Cases

Abstract

Miscarriage poses a significant threat to pregnant women globally. Recurrent miscarriages or potential poor embryonic development indicated by early drops in serum human chorionic gonadotrophin (hCG) are even more catastrophic for pregnant women. However, these patients receive either individualized medical intervention supported by limited evidence or no treatment at all. In this study, we report ten patients who shared at least one episode of an early decline of hCG in the first trimester and were treated with compassionate use of tumor necrosis factor-alpha inhibitor (TNFi). They were then followed up regularly with caution. Their hCG trajectory all resumed a normal pattern within one week and the obstetric outcomes were promising. No adverse fetal, neonatal, or maternal health issues have been observed. This case series supports current safety evidence of TNFi and provides new insight into its use in pregnancy when the embryo is in danger. Further well-designed clinical trials should be carried out to consolidate the evidence.

Tumour necrosis factor inhibitor combined with intravenous immunoglobulin and heparin for treatment of recurrent spontaneous abortion: A two‐centre, retrospective, cohort study

“…Recent studies show that RSA is linked with an unbalanced immune cell profile causing inflammatory/immune dysregulation in the uterine environment 7,8 . Inspired by this concept, recent clinical studies report the utilization of immunomodulation therapy in treating RSA patients with promising achievements 9,10 …”

“…Tumour necrosis factor inhibitors (TNFi) represent a variety of immunomodulation drugs with anti‐inflammatory effects by inhibiting the binding of TNF‐α with its receptors on immune cells to further prevent TNF‐α‐mediated inflammatory response 11,12 . The effect of TNFi on obstetric outcomes in RSA patients is not consistent 9,10,13–15 . For instance, a beneficial obstetric outcome for applying TNFi to treat RSA patients has been implied in several case reports 9,14,15 .…”

“…7,8 Inspired by this concept, recent clinical studies report the utilization of immunomodulation therapy in treating RSA patients with promising achievements. 9,10 Tumour necrosis factor inhibitors (TNFi) represent a variety of immunomodulation drugs with anti-inflammatory effects by inhibiting the binding of TNF-α with its receptors on immune cells to further prevent TNF-α-mediated inflammatory response. 11,12 The effect of TNFi on obstetric outcomes in RSA patients is not consistent.…”

“…11,12 The effect of TNFi on obstetric outcomes in RSA patients is not consistent. 9,10,[13][14][15] For instance, a beneficial obstetric outcome for applying TNFi to treat RSA patients has been implied in several case reports. 9,14,15 Moreover, one recent randomized controlled trial (RCT) reports that the application of TNFi improves the live birth rate in RSA patients treated with heparin, aspirin, prednisone, and cyclosporine.…”

“…9,10,[13][14][15] For instance, a beneficial obstetric outcome for applying TNFi to treat RSA patients has been implied in several case reports. 9,14,15 Moreover, one recent randomized controlled trial (RCT) reports that the application of TNFi improves the live birth rate in RSA patients treated with heparin, aspirin, prednisone, and cyclosporine. 10 However, another retrospective study conducted in America reports that TNFi combined with intravenous immunoglobulin (IVIG) and anticoagulants achieve a similar live birth rate than applying IVIG and anticoagulants in RSA patients.…”