Association of Treatments for Myeloproliferative Neoplasms During Pregnancy With Birth Rates and Maternal Outcomes

Maze, Dawn; Kazi, Sajida; Gupta, Vikas; Malinowski, Ann Kinga; Fazelzad, Rouhi; Shah, Prakesh S.; Shehata, Nadine

doi:10.1001/jamanetworkopen.2019.12666

Cited by 50 publications

(63 citation statements)

References 64 publications

(167 reference statements)

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“…NSAIDs, [38][39][40][41][42][43][44][45] two antiepileptics, [46][47][48] two β-blockers, [49][50][51] two calcium channel blockers, 50,52 two antiemetics (5-HT3 receptor antagonists), 53,54 two antipsychotics, 55,56 two antihistamines, 57,58 and one each assessed serotonin and norepinephrine reuptake inhibitors (SNRIs), 59,60 tricyclic antidepressants, 59,60 benzodiazepines, 61,62 corticosteroids, 63 oral magnesium, 64 triptans (5-HT1B/1D receptor agonists), 65 analgesics/antipyretics, 66 and intravenous magnesium. 67 Twelve SRs reported maternal adverse effects and 23 reported fetal/child adverse effects.…”

Section: All 26 Srs Assessed Pharmacologic Interventions: Eight Assessedmentioning

confidence: 99%

Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

et al. 2021

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Background: Primary headaches (migraine, tension headache, cluster headache, and other trigeminal autonomic cephalgias) are common in pregnancy and postpartum. It is unclear how to best and most safely manage them. Objective: We conducted a systematic review (SR) of interventions to prevent or treat primary headaches in women who are pregnant, attempting to become pregnant, postpartum, or breastfeeding. Methods: We searched Medline, Embase, Cochrane CENTRAL, CINAHL, ClinicalTrials. gov, Cochrane Database of SRs, and Epistemonikos for primary studies of pregnant women with primary headache and existing SRs of harms in pregnant women regardless of indication. No date or language restrictions were applied. We assessed strength of evidence (SoE) using standard methods. Results: We screened 8549 citations for studies and 2788 citations for SRs. Sixteen studies (mostly high risk of bias) comprising 14,185 patients (total) and 26 SRs met the criteria. For prevention, we found no evidence addressing effectiveness. Antiepileptics, venlafaxine, tricyclic antidepressants, benzodiazepines, β-blockers, prednisolone, and oral magnesium may be associated with fetal/child adverse effects, but calcium channel blockers and antihistamines may not be (1 single-group study and 11 SRs; lowto-moderate SoE). For treatment, combination metoclopramide and diphenhydramine may be more effective than codeine for migraine or tension headache (1 randomized controlled trial; low SoE). Triptans may not be associated with fetal/child adverse effects (8 nonrandomized comparative studies; low SoE). Acetaminophen, prednisolone, indomethacin, ondansetron, antipsychotics, and intravenous magnesium may be associated with fetal/child adverse effects, but low-dose aspirin may not be (indirect evidence; low-to-moderate SoE). We found insufficient evidence regarding non-pharmacologic treatments.

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Section: All 26 Srs Assessed Pharmacologic Interventions: Eight Assessedmentioning

confidence: 99%

Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

et al. 2021

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“…However, MPN patients are at increased risk for pregnancy related complications, the most common being spontaneous abortion. Other common pregnancy related complications include higher risk for thrombosis and hemorrhage, pre-eclampsia, and stillbirths [70,72,73]. Cytoreduction is considered in patients who have higher risk features following guidelines for cytoreduction in MPN and may be given in those with prior pregnancy losses and/or complications, history of thrombosis, or extreme thrombocytosis leading to increased risk of bleeding [33,70,74].…”

Section: Pregnant Populationsmentioning

confidence: 99%

“…Of 78 pregnancies treated with interferon reported in the literature, the live birth rate was 94%, with no fetal malformations [70]. Indeed, a meta-analysis showed improved live birth rates in ET women who were treated with interferon during their pregnancy [73]. Despite the association with improved outcomes, interferon use is typically reserved for high-risk pregnancies and it is unknown whether there would be any benefit in patients without traditional indication for cytoreduction.…”

Section: Pregnant Populationsmentioning

confidence: 99%

Use of Interferon Alfa in the Treatment of Myeloproliferative Neoplasms: Perspectives and Review of the Literature

How

Hobbs

2020

Cancers

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Interferon alfa was first used in the treatment of myeloproliferative neoplasms (MPNs) over 30 years ago. However, its initial use was hampered by its side effect profile and lack of official regulatory approval for MPN treatment. Recently, there has been renewed interest in the use of interferon in MPNs, given its potential disease-modifying effects, with associated molecular and histopathological responses. The development of pegylated formulations and, more recently, ropeginterferon alfa-2b has resulted in improved tolerability and further expansion of interferon’s use. We review the evolving clinical use of interferon in essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF). We discuss interferon’s place in MPN treatment in the context of the most recent clinical trial results evaluating interferon and its pegylated formulations, and its role in special populations such as young and pregnant MPN patients. Interferon has re-emerged as an important option in MPN patients, with future studies seeking to re-establish its place in the existing treatment algorithm for MPN, and potentially expanding its use for novel indications and combination therapies.

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“…A recent meta-analysis reported that the live birth rate was higher in pregnant women with MPNs who received low-dose aspirin during pregnancy than in those managed with observation alone (odds ratio, 9.48; 95% confidence interval, 4.41 to 20.41) [ 74 ]. Low-molecular-weight heparin may reduce the risk of venous thromboembolism in the antepartum and postpartum periods without increasing the risk of bleeding, although the venous thromboembolism risk was not significantly different between pregnant patients with ET who used low-molecular-weight heparin and those who did not [ 75 ].…”

Section: Pregnant Women and Those Who Desire To Become Pregnantmentioning

confidence: 99%

“…Currently, both hydroxyurea and anagrelide are contraindicated for use during pregnancy. The only drug with proven safety and cytoreduction effects in pregnant patients is standard IFN-α[70][71][72][73].A recent meta-analysis reported that the live birth rate was higher in pregnant women with MPN who received low-dose aspirin during pregnancy than in those managed with observation alone (OR, 9.48; 95% CI, 4.41 -20.41)[74]. Low molecular weight heparin (LMWH) may reduce the risk of venous thromboembolism in the antepartum and postpartum periods without increasing the risk of bleeding, although the venous thromboembolism (VTE) risk was not statistically different between pregnant ET patients who did and did not use LMWH[75].…”

mentioning

confidence: 99%

The 2020 revision of the guidelines for the management of myeloproliferative neoplasms

Kim

Bae

Bang

et al. 2021

Korean J Intern Med

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In 2016, the World Health Organization (WHO) revised the diagnostic criteria of myeloproliferative neoplasms (MPNs) based on the discovery of disease-driving genetic aberrations and extensive analysis of the clinical characteristics of MPN patients. Recent studies have suggested that additional somatic mutations have clinical impacts on the prognosis of patients harboring these genetic abnormalities. Treatment strategies have also advanced with the introduction of JAK inhibitors, one of which has been approved for the treatment of myelofibrosis patients and hydroxyurea-resistant or intolerant polycythemia vera patients. Because recently developed drugs aim not only at hematologic responses but also at symptomatic and molecular responses, the response criteria were refined as well. Based on these changes, we have revised the guidelines by presenting the diagnosis, treatment, and risk stratification of MPNs that fit the reality in Korea.

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Association of Treatments for Myeloproliferative Neoplasms During Pregnancy With Birth Rates and Maternal Outcomes

Cited by 50 publications

References 64 publications

Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

Use of Interferon Alfa in the Treatment of Myeloproliferative Neoplasms: Perspectives and Review of the Literature

The 2020 revision of the guidelines for the management of myeloproliferative neoplasms

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