Chicken pox infection in a three months old infant exposed in utero to Adalimumab

Johnsson, Anna; Avlund, Sara; Grosen, Anne; Julsgaard, Mette

doi:10.1016/j.crohns.2012.07.020

Cited by 17 publications

(10 citation statements)

References 5 publications

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“…63 One case reported the death of an infant exposed to infliximab who developed disseminated bacille Calmette-Guérin after administration of the live bacille Calmette-Guérin vaccine. 64 However, another study reported 15 children exposed to anti-TNF in utero who had no serious complications after bacille Calmette-Guérin vaccination within 1 week of birth.…”

Section: Cyclosporinementioning

confidence: 99%

Care of the Pregnant Patient With Inflammatory Bowel Disease

Matro

2015

Obstetrics &Amp; Gynecology

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Inflammatory bowel disease affects women in their peak reproductive years. Patients and physicians often have questions regarding the effect of inflammatory bowel disease on a woman's ability to conceive and to carry a pregnancy safely to term as well as the effect of inflammatory bowel disease and the medications used to treat it on pregnancy outcomes. Women with inflammatory bowel disease have the same rates of fertility as women without inflammatory bowel disease unless they have had prior surgery in the pelvis or active disease. However, women with inflammatory bowel disease do have higher rates of adverse pregnancy outcomes. A multidisciplinary approach involving gastroenterologists, obstetricians, and maternal-fetal medicine physicians should focus on preconception planning and disease optimization before pregnancy. Women with inflammatory bowel disease should be followed as high-risk obstetric patients. Most medications used to treat inflammatory bowel disease can be continued safely during pregnancy and lactation. The greatest risk to the pregnancy is active disease, which can be precipitated by discontinuation of effective maintenance medications. Preconception counseling should include education regarding the low risk of most inflammatory bowel disease medications during pregnancy and lactation and the high risk of a significant disease flare during pregnancy. This review outlines important considerations for obstetricians caring for women with inflammatory bowel disease before and during pregnancy and in the postpartum period.

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Section: Cyclosporinementioning

confidence: 99%

Care of the Pregnant Patient With Inflammatory Bowel Disease

Matro

2015

Obstetrics &Amp; Gynecology

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“…90 However, individual cases of serious infection have been reported. 104 In the PIANO registry, there is one case of vertical histoplasmosis transfer involving a mother taking infliximab 10 mg/kg every 6 weeks, with the last dose given at 32 weeks gestation. She delivered prematurely 4 weeks later and had supratherapeutic infliximab levels at birth.…”

Section: Placental Transfer and Infant Drug Exposurementioning

confidence: 98%

Use of Immunomodulators and Biologics Before, During, and After Pregnancy

McConnell

M²

2016

Inflammatory Bowel Diseases

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Immunomodulators and biologic medications, alone or in combination, form the core therapeutic strategy for managing moderate-to-severe inflammatory bowel disease (IBD). IBD incidence peaks during the prime reproductive years, raising concerns about the impact of disease and its treatment on fertility, maternal and fetal health during pregnancy, breastfeeding safety, and childhood development. Although IBD increases risk of pregnancy complications independent of disease activity, adverse pregnancy outcomes are more common when disease is active. To mitigate fetal risk, women should conceive while disease is quiescent. Aside from methotrexate, immunomodulators and biologics may be used during pregnancy to achieve and maintain disease control. Based on available safety data, there is no increased risk of congenital anomalies among infants exposed to these medications. Active thiopurine metabolites and most monoclonal antibodies cross the placenta and are detectable in neonates. They are detectable in breast milk in minute levels as well. The impact of this exposure on neonatal outcomes is discussed. Adjusted dosing schedules during gestation may reduce fetal drug exposure, though the maternal risks of such manipulation require careful consideration. Ongoing prospective studies will further inform risk assessment, including for newer medications such as the anti-integrin agents.

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“…85,88 Furthermore, routine childhood vaccinations were well tolerated, resulting in no safety concerns or severe AEs. [85][86][87][88][89][90][91] More recently, data from the Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes (PIANO) registry comparing vaccine responses in infants born of mothers who were exposed to biologic therapies (IFX, adalimumab, vedolizumab, certolizumab pegol, golimumab, natalizumab, or ustekinumab) vs those unexposed during gestation revealed no significant differences in seroprotection rates to the Hib ( 92 Three case reports examined the efficacy of routine childhood immunizations such as tetanus, diphtheria, and HBV among infants exposed to RTX up to the third trimester (last RTX dose at 30-34 weeks' gestation). [93][94][95] Despite all infants exhibiting low 94 or undetectable 93,95 B-cell counts at birth, protective antibody levels were generally achieved following vaccination without serious AEs.…”

Section: Evidence Summarymentioning

confidence: 99%

“…93,94,105 In fact, studies demonstrated that infants exposed to either TNFi or RTX in utero achieved protective antibody levels without complications upon completion of the MMR vaccine regimen. 85,90,93,95 Similarly, nonbiologic immunomodulatory agents with relatively long half-lives such as leflunomide (14 days) and antimalarials (40-50 days) are expected to be cleared or present in minute concentrations that are unlikely to negatively affect the immunogenicity or safety of vaccines given ⩾12 months after birth.…”

Section: Evidence Summarymentioning

confidence: 99%

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Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies

et al. 2018

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Background:Patients with immune-mediated diseases on immunosuppressive therapies have more infectious episodes than healthy individuals, yet vaccination practices by physicians for this patient population remain suboptimal.Objectives:To evaluate the safety and efficacy of vaccines in individuals exposed to immunosuppressive therapies and provide evidence-based clinical practice recommendations.Methods:A literature search for vaccination safety and efficacy in patients on immunosuppressive therapies (2009-2017) was conducted. Results were assessed using the Grading of Recommendation, Assessment, Development, and Evaluation system.Results:Several immunosuppressive therapies attenuate vaccine response. Thus, vaccines should be administered before treatment whenever feasible. Inactivated vaccines can be administered without treatment discontinuation. Similarly, evidence suggests that the live zoster vaccine is safe and effective while on select immunosuppressive therapy, although use of the subunit vaccine is preferred. Caution regarding other live vaccines is warranted. Drug pharmacokinetics, duration of vaccine-induced viremia, and immune response kinetics should be considered to determine appropriate timing of vaccination and treatment (re)initiation. Infants exposed to immunosuppressive therapies through breastmilk can usually be immunized according to local guidelines. Intrauterine exposure to immunosuppressive agents is not a contraindication for inactivated vaccines. Live attenuated vaccines scheduled for infants and children ⩾12 months of age, including measles, mumps, rubella, and varicella, can be safely administered as sufficient time has elapsed for drug clearance.Conclusions:Immunosuppressive agents may attenuate vaccine responses, but protective benefit is generally maintained. While these recommendations are evidence based, they do not replace clinical judgment, and decisions regarding vaccination must carefully assess the risks, benefits, and circumstances of individual patients.

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Chicken pox infection in a three months old infant exposed in utero to Adalimumab

Cited by 17 publications

References 5 publications

Care of the Pregnant Patient With Inflammatory Bowel Disease

Care of the Pregnant Patient With Inflammatory Bowel Disease

Use of Immunomodulators and Biologics Before, During, and After Pregnancy

Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies

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