Drug Insight: anti-tumor necrosis factor therapy for inflammatory arthropathies during reproduction, pregnancy and lactation

Abstract

Tumor necrosis factor (TNF) antagonists are widely used to reduce disease activity and joint damage, and to improve health-related quality of life in patients suffering from rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis. To date, no increased risk of embryotoxicity or teratogenicity, or adverse pregnancy outcome (such as birth defects, premature birth, and low birth weight) has been reported in patients with inflammatory arthropathies treated with anti-TNF therapy, compared with the general population. However, the available data are limited, and methotrexate, which is commonly used in combination with anti-TNF drugs, is teratogenic. Until more data are available, no firm conclusions can be reached regarding the safety of anti-TNF therapy in pregnancy. Nevertheless, in selected cases where there is high disease activity, anti-TNF therapy might be recommended, depending on the results of individual risk-benefit analyses. Fully informed consent from the mother is needed in such cases. Anti-TNF agents are not usually used during lactation, although the risk of toxicity is probably negligible.

Treatment of Psoriasis with Anti-TNF Drugs during Pregnancy: Case Report and Review of the Literature

“…The authors believe that women for whom these drugs are essential to control their psoriasis must be carefully evaluated case-by-case and can be encouraged to proceed, with caution and fully informed consent, on the basis of the currently available data [32]. In order to minimize fetal exposure, it would be advisable to administer the last infusion before week 30 of pregnancy, and resume treatment after delivery.…”

A series of critically challenging case scenarios in moderate to severe psoriasis: A Delphi consensus approach

“…Most studies demonstrate the TNF-inhibitors as non-teratogenic and safe in scenarios in which the potential benefits are deemed to outweigh the risks. 287,288 Toxicity studies in animals show no fetal harm. It should be noted that one case report links the use of high-dose etanercept to a rare congenital syndrome (the vertebral defects, anal atresia, tracheoesophageal fistula with esophageal atresia, and radial and renal anomalies association [VATER]) comprising multiple malformations.…”

Approach to the Management of the Pregnant Inflammatory Bowel Disease Patient: Successful Outcome

“…The authors recommended that such therapy be avoided after 30 weeks gestation when possible. As of the date of this publication, no increased risk of embryotoxicity, teratogenicity or adverse pregnancy outcome has been reported in patients treated with anti-TNF therapy (Skomsvoll et al, 2007). The majority of studies regarding breast feeding while receiving anti-TNF therapy has not demonstrated any adverse outcomes.…”