Ciclosporin Use During Pregnancy

Paziana, Karolina; Monaco, Magaly Del; Cardonick, Elyce; Moritz, Michael J.; Keller, Matthew; Smith, B. Davison; Coscia, Lisa A.; Armenti, Vincent T.

doi:10.1007/s40264-013-0034-x

Cited by 123 publications

(95 citation statements)

References 101 publications

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“…Overall, with the exception of mycophenolic acid, the risks of cyclosporine, tacrolimus, AZA, sirolimus, everolimus, and corticosteroids appear low compared with the risks of acute cellular rejection or graft loss with their discontinuation or attenuation. Although a higher risk of prematurity and LBW have been reported, the risks of congenital malformation do not appear to be signifi cantly higher than the risk in the general population, without a specifi c pattern of malformation identifi ed (187)(188)(189)(190)(191)(192). Compared with tacrolimus and cyclosporine, there is less data on the use of everolimus and sirolimus during pregnancy aft er liver transplantation, with more of the data available for kidney transplant recipients.…”

Section: Primary Biliary Cirrhosismentioning

confidence: 98%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

242

257

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Consultation for liver disease in pregnant women is a common and oftentimes vexing clinical consultation for the gastroenterologist. The challenge lies in the need to consider the safety of both the expectant mother and the unborn fetus in the clinical management decisions. This practice guideline provides an evidence-based approach to common diagnostic and treatment challenges of liver disease in pregnant women. Am J Gastroenterol 2016; 111:176-194; doi: 10.1038/ajg.2015 Initial evaluation of pregnant patientA pregnant patient presenting with abnormal liver tests should undergo standard workup as with any non-pregnant individual (strong recommendation, very low level of evidence). Imaging in pregnancyUltrasound is safe and the preferred imaging modality used in assessment of abnormal liver tests suggestive of biliary tract disease (strong recommendation, low level of evidence).Magnetic resonance imaging without gadolinium can be used in the second and third trimester (conditional recommendation, low level of evidence).Computed tomography scans carry a risk of teratogenesis and childhood hematologic malignancies but may be used judiciously with minimized radiation protocols (2-5 rads; conditional recommendation, very low level of evidence). Endoscopy in pregnancyEndoscopy is safe in pregnancy but should be deferred until the second trimester if possible (strong recommendation, low level of evidence).Meperidine and propofol can be used for endoscopic sedation (strong recommendation, moderate level of evidence). Management of biliary disease in pregnancyERCP can be performed when indicated for pregnant women presenting with biliary disease that strongly necessitates intervention such as biliary pancreatitis, symptomatic choledocholithiasis, and/or cholangitis. Minimizing fetal exposure to fl uoroscopy is imperative (strong recommendation, low level of evidence).Symptomatic cholecystitis should be managed with early surgical intervention with laparoscopic cholecystectomy (strong recommendation, low level of evidence). Liver masses in pregnancyAsymptomatic hemangioma and focal nodular hyperplasia do not need routine imaging or surveillance during pregnancy (strong recommendation, very low level evidence).Hepatic adenomas should be monitored with ultrasound during pregnancy for growth. Patients with large adenomas (>5 cm) should be referred for resection prior to pregnancy (strong recommendation, low level of evidence). Hepatitis B in pregnancyActive-passive immunoprophylaxis with hepatitis B immunoglobulin and the HBV vaccination series should be administered to all infants born to HBV-infected mothers to prevent perinatal transmission (strong recommendation, low level of evidence).Women chronically infected with HBV and high viral load (>10 6 log copies/ml (200,000 IU/ml) and higher) should be offered antiviral medication with tenofovir or telbivudine in the third trimester to reduce perinatal transmission of HBV (strong recommendation, low level of evidence).C-section should not be performed electively in HBV-pos...

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Section: Primary Biliary Cirrhosismentioning

confidence: 98%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

242

257

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“…Data on severe PG cases with immunosuppressive medication are sparse, and the benefit to the mother needs to be weighed against possible risks to the foetus and the newborn. Cyclosporine down-regulates T-cell function, and it has been used during pregnancy in organ transplant patients and in various autoimmune diseases with no association with increased risk of congenital malformations (16). As a lipophilic agent, cyclosporine diffuses across the placenta and enters the foetal circulation and tissues (16), and can increase foetal exposure to other drugs (17).…”

Section: Discussionmentioning

confidence: 99%

Cyclosporine Treatment in Severe Gestational Pemphigoid

Huilaja¹,

Mäkikallio²,

Hannula-Jouppi³

et al. 2015

Acta Derm Venerol

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Gestational pemphigoid, a rare autoimmune skin disease typically occurring during pregnancy, is caused by autoantibodies against collagen XVII. Clinically it is characterised by severe itching followed by erythematous and bullous lesions of the skin. Topical or oral glucocorticoids usually relieve symptoms, but in more severe cases systemic immunosuppressive treatments are needed. Data on immunosuppressive medication controlling gestational pemphigoid are sparse. We report 3 intractable cases of gestational pemphigoid treated with cyclosporine.

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“…However, cyclosporine pregnancy data from the renal transplant literature suggest increased rates of preterm delivery, small for gestational age, gestational diabetes, maternal hypertension, preeclampsia, and fluctuations in drug levels. 74 A metaanalysis of pregnancy outcomes after cyclosporine therapy reported a 56% prevalence of preterm delivery and a 4.1% rate of congenital anomalies. 75 Whether these findings reflect underlying disease severity, cyclosporine effect, or both is unknown.…”

Section: Methotrexatementioning

confidence: 99%

Use of Immunomodulators and Biologics Before, During, and After Pregnancy

McConnell

M²

2016

Inflammatory Bowel Diseases

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Immunomodulators and biologic medications, alone or in combination, form the core therapeutic strategy for managing moderate-to-severe inflammatory bowel disease (IBD). IBD incidence peaks during the prime reproductive years, raising concerns about the impact of disease and its treatment on fertility, maternal and fetal health during pregnancy, breastfeeding safety, and childhood development. Although IBD increases risk of pregnancy complications independent of disease activity, adverse pregnancy outcomes are more common when disease is active. To mitigate fetal risk, women should conceive while disease is quiescent. Aside from methotrexate, immunomodulators and biologics may be used during pregnancy to achieve and maintain disease control. Based on available safety data, there is no increased risk of congenital anomalies among infants exposed to these medications. Active thiopurine metabolites and most monoclonal antibodies cross the placenta and are detectable in neonates. They are detectable in breast milk in minute levels as well. The impact of this exposure on neonatal outcomes is discussed. Adjusted dosing schedules during gestation may reduce fetal drug exposure, though the maternal risks of such manipulation require careful consideration. Ongoing prospective studies will further inform risk assessment, including for newer medications such as the anti-integrin agents.

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Ciclosporin Use During Pregnancy

Cited by 123 publications

References 101 publications

ACG Clinical Guideline: Liver Disease and Pregnancy

ACG Clinical Guideline: Liver Disease and Pregnancy

Cyclosporine Treatment in Severe Gestational Pemphigoid

Use of Immunomodulators and Biologics Before, During, and After Pregnancy

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