Pregnancy outcome following in utero exposure to azathioprine: A French comparative observational study

Alami, Z.; Agier, M.-S.; Ahid, S.; Vial, Thierry; Dautriche, Anne; Lagarce, Laurence; Toutain, Annick; Cherrah, Yahia; Jonville-Béra, Annie Pierre

doi:10.1016/j.therap.2017.06.006

Cited by 33 publications

(14 citation statements)

References 38 publications

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“…Although an increasing body of evidence from cohort studies suggests that AZA is safe for the fetus during hydropregnancy [18], a previous study of 476 pregnancies with AZA exposure, mostly for inflammatory bowel disease and systemic lupus erythematosus, suggested an association between AZA exposure and atrial or ventricular septal defects [19]. There are also some indications of increased risk of premature births and lower birth weight after maternal AZA exposure [20‐22]. Therefore, the benefit of continuing AZA during pregnancy should be weighed against the possible risk to the child.…”

Section: Discussionmentioning

confidence: 99%

Outcome of pregnancies after onset of the neuromyelitis optica spectrum disorder

Kim

Huh

Jang

et al. 2020

Euro J of Neurology

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Background and purpose Data on the pregnancy outcome of neuromyelitis optica spectrum disorder (NMOSD) remain limited, especially for woman who had received immunosuppressive treatment before becoming pregnant. The aim was to evaluate the outcome of pregnancy amongst patients with NMOSD who attempted to become pregnant after NMOSD onset and to identify risk factors that predict pregnancy‐related attack. Methods Medical records from 29 patients who attempted to become pregnant after NMOSD onset were retrospectively evaluated and the patients were interviewed for pregnancy outcomes. Pregnancy‐related attack was defined as an attack that occurred during pregnancy or within 1 year of delivery. Results Amongst the 29 patients, 26 had 33 pregnancies after NMOSD symptom onset. The 33 pregnancies after NMOSD onset resulted in 24 live births (healthy neonates except one with low birth weight), six miscarriages and three elective abortions. Pregnancy‐related attack occurred in nine (75%) of 12 pregnancies before initiation of immunosuppressive therapy, but in only five (24%) of 21 pregnancies after initiation of immunosuppressive therapy (P = 0.009). Multivariable analysis indicated that pregnancy‐related attack was negatively associated with pregnancy after initiation of rituximab (odds ratio 0.048, 95% confidence interval 0.004–0.546). Conclusion Successful pregnancy without maternal and neonatal complications may be feasible in patients with NMOSD. Rituximab treatment before pregnancy might help to prevent pregnancy‐related attack in patients with NMOSD.

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Section: Discussionmentioning

confidence: 99%

Outcome of pregnancies after onset of the neuromyelitis optica spectrum disorder

Kim

Huh

Jang

et al. 2020

Euro J of Neurology

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“…Patients should have a full blood count and liver function tests weekly, until on the maintenance dose for 8 weeks, and then 3 monthly if test parameters remain stable. Azathioprine is felt to be safe in pregnancy and thus is a good choice for female children of all ages, likely to need long term treatment ( 45 ).…”

Section: Treatment Of Jmgmentioning

confidence: 99%

Management of Juvenile Myasthenia Gravis

2020

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Juvenile Myasthenia Gravis (JMG) is a rare disorder, defined as myasthenia gravis in children younger than 18 years of age. While clinical phenotypes are similar to adults, there are a number of caveats that influence management: broader differential diagnoses; higher rates of spontaneous remission; and the need to initiate appropriate treatment early, to avoid the long-term physical and psychosocial morbidity. Current practice is taken from treatment guidelines for adult MG or individual experience, with considerable variability seen across centers. We discuss our approach to treating JMG, in a large specialist JMG service, and review currently available evidence and highlight potential areas for future research. First-line treatment of generalized JMG is symptomatic management with pyridostigmine, but early use of immunosuppression, where good control is not achieved is important. Oral prednisolone is used as first-line immunosuppression with appropriate prevention and monitoring of side effects. Second-line therapies including azathioprine and mycophenolate may be considered where there is: no response to steroids, inability to wean to a reasonable minimum effective dose or if side-effects are intolerable. Management of ocular JMG is similar, but requires close involvement of ophthalmology in young children to prevent amblyopia. Muscle-specific tyrosine kinase (MuSK)-JMG show a poorer response to pyridostigmine and anecdotal evidence suggests that rituximab should be considered as second-line immunosuppression. Thymectomy is indicated in any patient with a thymoma, and consideration should be given in acetylcholine receptor (AChR) positive JMG allowing time for spontaneous remission. The benefit is less clear in ocular JMG and is not advised in MuSK-JMG. Children experiencing a myasthenic crisis require urgent hospital admission with access to the intensive care unit. PLEX is preferred over IVIG due to rapid onset of action, but this needs to be balanced with feasibility in very young children. Key questions remain in the management of JMG: when to initiate both first- and second-line treatments, choosing between steroid-sparing agents, and determining the optimal dose and treatment duration. We feel that given the rarity of this disease, the establishment of national registries and collaboration across groups will be needed to address these issues and facilitate future drug trials in JMG.

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“…No infant had major congenital abnormalities [32]. Using the French pregnancy database a prospective comparative study reported that first trimester exposure to azathioprine in 124 pregnancies was not associated with an elevated rate of birth defects [33]. Also in organ transplanted women, the use of azathioprine during pregnancy is considered to be relatively safe [30,34,35,36].…”

Section: Nucleotide Synthesis Inhibitorsmentioning

confidence: 99%

Fetal Toxicity of Immunosuppressive Drugs in Pregnancy

Ponticelli

Moroni

2018

JCM

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Women affected by autoimmune diseases, organ transplantation, or neoplasia need to continue immunosuppressive treatment during pregnancy. In this setting, not only a careful planning of pregnancy, but also the choice of drugs is critical to preventing maternal complications and minimizing the fetal risks. Some immunosuppressive drugs are teratogenic and should be replaced even before the pregnancy, while other drugs need to be managed with caution to prevent fetal risks, including miscarriage, intrauterine growth restriction, prematurity, and low birth weight. In particular, the increasing use of biologic agents raises the question of their compatibility with reproduction. In this review we present data on the indication and safety in pregnancy of the most frequently used immunosuppressive drugs.

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Pregnancy outcome following in utero exposure to azathioprine: A French comparative observational study

Cited by 33 publications

References 38 publications

Outcome of pregnancies after onset of the neuromyelitis optica spectrum disorder

Outcome of pregnancies after onset of the neuromyelitis optica spectrum disorder

Management of Juvenile Myasthenia Gravis

Fetal Toxicity of Immunosuppressive Drugs in Pregnancy

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