The Efficacy and Safety of Cyclosporin A in Pregnant Patients with Systemic Autoimmune Diseases

Reggia, Rossella; Bazzani, Chiara; Andréoli, Laura; Motta, Mario; Lojacono, Andrea; Zatti, Sonia; Ramazzotto, Francesca; Nuzzo, Monica; Tincani, Anǵela

doi:10.1111/aji.12514

Cited by 22 publications

(14 citation statements)

References 40 publications

(44 reference statements)

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“…UKTIS draws a similar conclusion [171]. We identified an additional five studies of 550 pregnancy exposures [182,185,[219][220][221]. Three studies reported on maternal exposure [182,219,220].…”

Section: Ciclosporinmentioning

confidence: 52%

British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids

et al. 2022

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Section: Ciclosporinmentioning

confidence: 52%

British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids

et al. 2022

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“…Overall, the continued use of CNI in pregnancy is considered safe in rheumatology and posttransplant patients. [ 62 ]…”

Section: Difficult‐to‐treat Aih In Pregnancymentioning

confidence: 99%

“…Overall, the continued use of CNI in pregnancy is considered safe in rheumatology and posttransplant patients. [62] The pharmacokinetics of tacrolimus alters in pregnancy with a rise in the unbound (active) component and reduction in the whole-blood concentrations of tacrolimus, which is measured for TDM. [64] Clinicians may increase tacrolimus dosage, which further increases the unbound tacrolimus concentration.…”

Section: Calcineurin Inhibitorsmentioning

confidence: 99%

Autoimmune hepatitis in pregnancy: Pearls and pitfalls

Chung

Heneghan

2022

Hepatology

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Autoimmune hepatitis (AIH) in pregnancy has many unique considerations.Evidence provided from single center studies with patient level data and nationwide population studies provide valuable insight into this complex situation. Because a planned pregnancy is a safer pregnancy, preconception counseling is a crucial opportunity to optimize care and risk stratify women with AIH. Women with chronic liver disease who receive preconception advice and counseling are more likely to achieve stable liver disease at conception and undergo appropriate variceal surveillance. Loss of biochemical response in pregnancy is associated with adverse outcomes in unstable disease. New onset AIH in pregnancy should be managed with classical treatment regimens. The continued use of immunosuppression in pregnancy, with the exception of mycophenolate mofetil, has not shown to adversely affect the rates of stillbirth or congenital malformation. Previously adopted immunosuppression withdrawal paradigms in pregnancy should no longer be considered advantageous, because remission loss postdelivery is likely (12%-86%). Population studies, report improved outcomes with preterm birth rates falling from 20% to 9%-13% in AIH pregnancies over a 20-year period.Newer data have also demonstrated an increased risk of gestational diabetes and hypertensive complications in AIH pregnancy, which has implications for management and preeclampsia prevention with aspirin use. This review aims to provide the framework to guide and manage pregnancy in AIH outlining pearls and pitfalls to ensure optimal outcomes for mother, baby and to reduce variation in practice.

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“…There is comprehensive evidence on the use of ciclosporin during pregnancy from the fields of transplantation medicine and rheumatology. No evidence of teratogenicity has been found [70][71][72]. Increased rates of premature births and lower birth weights compared to the general population have been reported, but this may conceivably be attributed to the underlying diseases of the patients.…”

Section: Ciclosporinmentioning

confidence: 99%

Therapy of psoriasis during pregnancy and breast‐feeding

Gerdes

Beissert

Ochsendorf

et al. 2022

J Deutsche Derma Gesell

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Summary There have been multiple systemic drugs approved for the therapy of psoriasis vulgaris and psoriasis arthritis (PsA) in the last decade. However, treatment decisions are difficult to make in women planning a pregnancy and in pregnant and lactating women due to the paucity of data for such cases. The strongest evidence for psoriasis therapy during pregnancy exists for topical corticosteroids. Medically controlled use of UVB‐therapy is also considered safe. The best evidence regarding systemic therapy during pregnancy and lactation is available for the group of TNF‐alpha inhibitors, which is also reflected in the respective medical product information. This is especially important in cases of psoriatic arthritis. Among traditional systemic therapeutics, the largest clinical experience exists for ciclosporin, which, if medically necessary, may be continued during gestation. However, TNF‐alpha inhibitors, especially the pegylated form, should be preferred in case of pregnancy. Furthermore, an elective pregnancy termination is not necessary due to systemic therapy of psoriasis with many further substances during the first pregnancy weeks. The current work provides a comprehensive review of the scientific literature on treatment of psoriasis during pregnancy and lactation. Based on the available scientific information, severity of psoriasis and patient’s comorbidities, the best possible therapeutic approach can be found in consensus with the patient.

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The Efficacy and Safety of Cyclosporin A in Pregnant Patients with Systemic Autoimmune Diseases

Cited by 22 publications

References 40 publications

British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids

British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids

Autoimmune hepatitis in pregnancy: Pearls and pitfalls

Therapy of psoriasis during pregnancy and breast‐feeding

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