A Woman with Rheumatoid Arthritis Who Successfully Delivered a Healthy Child with Continuous Administration of Sarilumab Throughout Pregnancy

Mizutani, Satoshi; Okunishi, Yuki; Tamada, Tatsuya; Tanaka, Hiroyuki; Ito, Yuhei; Yamamoto, Y.; Kitamura, Asa; Tanaka, Hiroaki; Ikeda, Tomoaki; Nakajima, Ayako

doi:10.2169/internalmedicine.9607-22

Cited by 2 publications

(1 citation statement)

References 20 publications

(21 reference statements)

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“…Generally, studies have not found evidence to support significant immunosuppression by TNFα inhibitors since there is no observed increase in infection rates in exposed infants, regardless of whether exposure occurred early or late in pregnancy [22 ▪▪ ,24]. Overall, the recommendation from rheumatologic societies is to continue TNFα inhibitors throughout pregnancy and transiently hold them during the third trimester, if the underlying disease is well controlled [22 ▪▪ ,25,29,30,38,39,40 ▪ ,41,42,43 ▪ ,44] (Table 2).…”

Section: Potential To the Fetus And Newborn Due To Biologics Usementioning

confidence: 99%

Safety of biologic agents for the management of rheumatic diseases during pregnancy

D’Gama,

Bermas

2024

Current Opinion in Rheumatology

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Purpose of review To discuss the current understanding regarding the use of biologic therapeutics in pregnancy. Recent findings Our understanding of the mechanisms underlying the potential fetal and infant exposure to biologics as well as a growing body of empirical evidence from real world use of biologics in pregnancy have demonstrated that biologics are generally compatible preconception and during pregnancy. Long-term effects of exposure to biologic agents in utero are not known, but will be uncovered in time. Biosimilars, which are becoming more popular, may not always share the same safety profiles as their originators. Summary Biologics have revolutionized the management of rheumatologic disease and ushered in a new era of clinical remission among patients. These agents, developed and introduced into clinical use at the beginning of the new millennium, are very potent, yet their efficacy in treating disease often in reproductive aged women, raises questions regarding their safety during pregnancy. These therapeutics can cause immunosuppression and can inhibit immunologic circuits that are not only involved in disease pathophysiology but hypothetically could impact the development of the fetal immune system. Reassuringly, biologics, typically antibodies or antibody-based proteins, are introduced to the fetus via the typical route of transplacental antibody transfer, and thus only begin to be transferred in appreciable amounts in the second trimester (after organogenesis). From theoretic and empirical standpoints, biologic use during pregnancy appears well tolerated for fetal development and to not substantially affect infant immune development.

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Section: Potential To the Fetus And Newborn Due To Biologics Usementioning

confidence: 99%