Safety of anti-TNF therapy in inflammatory bowel disease during pregnancy

Khan, Nabeel; Asim, Hamna; Lichtenstein, Gary R.

doi:10.1517/14740338.2014.973399

Cited by 30 publications

(11 citation statements)

References 95 publications

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“…A 2014 review of 105 articles on the use of anti-TNF therapy in patients with IBD and pregnancy found that anti-TNF agents were safe during pregnancy, and the authors even recommended maintained use and initiation of therapy with anti-TNF agents for patients who were refractory to azathioprine, steroids, and 5-aminosalicylate (Khan et al, 2014). Clowse (2010) looked at the effect on pregnancy of infliximab, adalimumab, and etanercept both combined and individually compared with the general population and found no significant differences in the number of live-born infants, miscarriages, elective terminations, or congenital abnormalities.…”

Section: General Safety Of Biologic Agents During Pregnancymentioning

confidence: 99%

Update on biologic safety for patients with psoriasis during pregnancy

Porter

Lockwood

Kimball

2017

International Journal of Women's Dermatology

101

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Biologic agents have become more common to treat patients with psoriasis, but concerns about their effect on pregnancy and lactation often preclude this treatment during these time periods. During the past decade, we have gained a much better understanding of the course of psoriasis during pregnancy and the safety of the use of biologic agents during pregnancy and lactation. Under certain circumstances, biologic agents can be considered appropriate treatment options for patients who are pregnant or lactating.

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Section: General Safety Of Biologic Agents During Pregnancymentioning

confidence: 99%

Update on biologic safety for patients with psoriasis during pregnancy

Porter

Lockwood

Kimball

2017

International Journal of Women's Dermatology

101

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“…Among 50 pregnancies exposed to TNF‐α antagonists (etanercept in 36 cases) for rheumatologic diseases, two congenital malformations were noted . Khan et al reported 37 pregnancies treated with adalimumab for bowel inflammatory diseases with no adverse effect on the pregnancy or fetal outcomes. Until 2015, among 472 reported pregnancies under TNF‐α antagonists, an 85.8% rate of live birth (vs 64.6% of general USA population) was noted without increased risk of congenital abnormalities .…”

Section: Immunomodulatory Treatmentsmentioning

confidence: 99%

Unexplained Recurrent Miscarriage and Recurrent Implantation Failure: Is There a Place for Immunomodulation?

Mékinian

Cohen

Alijotas‐Reig

et al. 2016

American J Rep Immunol

140

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To describe and analyze the benefit of immunomodulatory drugs for recurrent miscarriages and implantation failures. The literature research was conducted in Medline, Embase and Cochrane Library concerning recurrent miscarriages and implantation failures and steroids, progesterone, intralipids, TNF-α antagonists, G-CSF, hydroxychloroquine, intravenous immunoglobulins, endometrial scratching. Using meta-analysis, modest benefit was found for progesterone to obtain a live birth, with odds ratio at 1.38 (95% CI: 1.07-1.77) and significant heterogeneity (P = 0.01, I(2) = 78%). In early ≥3 miscarriages, patients treated by TNF-α antagonists (adalimumab or etanercept; n = 17) combined with low-dose aspirin, heparin and intravenous immunoglobulins have a live births of 71% (12/17), vs 19% with aspirin+heparin (4/21) (P = 0.0026). Sixty-eight patients with unexplained recurrent miscarriage were randomized to receive either G-CSF (filgastrim, Neupogen, 1 μ/kg/day SC, n = 35) after the ovulation until the 9th weeks of gestation or placebo (n = 33). Among patients treated with G-CSF, 29/35 (82.8%) have live birth and 16/33 (48.5%) of controls (P = 0.006). Among 200 women with recurrent miscarriages and implantation failure treated with intralipids, the pregnancy rate was 52%, with pregnancy ongoing/live birth rate at 91%. The physiopathological rational for immunotolerance failure in this topic raise the need to demonstrate the efficacy of immunomodulatory drugs, define the patients subsets and develop treatment strategies.

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“…Small studies indicate no increase of infections during the first year of life of newborns after intrauterine exposure to TNF inhibitors, normal response to vaccination, and developmental milestones achieved in a timely manner [96]. In contrast to these reassuring data, a small case series describes the presence of transient severe neutropenia, subsequently complicated by skin infections, in four newborns after intrauterine exposure to infliximab (including the third trimester) [102].…”

Section: Tnf Inhibitors and Pregnancymentioning

confidence: 99%