Conception and course of eight pregnancies in five women on TNF blocker etanercept treatment

Rump, J. A.; Schönborn, H.

doi:10.1007/s00393-010-0652-y

Cited by 21 publications

(2 citation statements)

References 14 publications

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“…Nevertheless, their use during pregnancy is still controversial, because it remains unclear whether the benefits of treatment might be outweighed by potential teratogenicity or adverse effects on the course of pregnancy. Based on the available literature, experts suggest that continuation of treatment with TNF-α blockers is justified in pregnant patients with high disease activity and disease progression 95–97…”

Section: Safety Of Etanercept In Asmentioning

confidence: 99%

Long-term safety and efficacy of etanercept in the treatment of ankylosing spondylitis

Gallego¹,

Santos-Ramírez²,

Santos-Soler³

et al. 2013

PPA

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To date, anti-tumor necrosis factor alfa (anti-TNF-α) therapy is the only alternative to nonsteroidal anti-inflammatory drugs for the treatment of ankylosing spondylitis. Etanercept is a soluble TNF receptor, with a mode of action and pharmacokinetics different to those of antibodies and distinctive efficacy and safety. Etanercept has demonstrated efficacy in the treatment of ankylosing spondylitis, with or without radiographic sacroiliitis, and other manifestations of the disease, including peripheral arthritis, enthesitis, and psoriasis. Etanercept is not efficacious in inflammatory bowel disease, and its efficacy in the treatment of uveitis appears to be lower than that of other anti-TNF drugs. Studies of etanercept confirmed regression of bone edema on magnetic resonance imaging of the spine and sacroiliac joint, but failed to reduce radiographic progression, as do the other anti-TNF drugs. It seems that a proportion of patients remain in disease remission when the etanercept dose is reduced or administration intervals are extended. Etanercept is generally well tolerated with an acceptable safety profile in the treatment of ankylosing spondylitis. The most common adverse effect of etanercept treatment is injection site reactions, which are generally self-limiting. Reactivation of tuberculosis, reactivation of hepatitis B virus infection, congestive heart failure, demyelinating neurologic disorders, hematologic disorders like aplastic anemia and pancytopenia, vasculitis, immunogenicity, and exacerbation or induction of psoriasis are class effects of all the anti-TNF drugs, and have been seen in patients with ankylosing spondylitis. However, etanercept is less likely to induce reactivation of tuberculosis than the other anti-TNF drugs and it has been suggested that etanercept might be less immunogenic, especially in ankylosing spondylitis. Acute uveitis, Crohn’s disease, and sarcoidosis are other adverse events that have been rarely associated with etanercept therapy in patients with ankylosing spondylitis.

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Section: Safety Of Etanercept In Asmentioning

confidence: 99%

Long-term safety and efficacy of etanercept in the treatment of ankylosing spondylitis

Gallego¹,

Santos-Ramírez²,

Santos-Soler³

et al. 2013

PPA

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“…Several case series, case reports, and retrospective studies have concluded that adalimumab, etanercept, and infliximab have all been consistent with the old FDA categorization of pregnancy class B (Berthelot et al, 2009, Carter et al, 2006, Kane et al, 2009, Katz et al, 2004, Mahadevan et al, 2005, Mishkin et al, 2006, Murashima et al, 2009, Rump and Schönborn, 2010). This is all consistent with the 2012 NPF recommendations that these drugs should be regarded as third-line treatments for pregnant psoriasis patients (Bae et al, 2012).…”

mentioning

confidence: 76%

Considerations on biologic agents in psoriasis with the new pregnancy lactation labeling rule

Abrouk

Beroukhim

Nakamura

et al. 2017

International Journal of Women's Dermatology

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Emerging data on the use of anti‐tumor necrosis factor‐alpha medications in pregnancy

Chambers

Johnson

2012

Birth Defects Research

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Anti-tumor necrosis factor (TNF) α medications are used for the treatment of a number of autoimmune diseases. Evaluation of pregnancy safety for these medications is complicated by the contribution of the underlying maternal disease to adverse pregnancy outcomes, such as preterm delivery and reduced birth weight. Placental transport of these medications is thought to be minimal in the first trimester, thereby providing some reassurance regarding theoretical risks for congenital malformations. Available human exposure data are sparse; however, to date there has been no convincing evidence to support an increased risk for a specific pattern of major congenital malformations with any of the drugs in this group for which some data is currently available. As a result of the improvement of symptoms during pregnancy in some women with autoimmune diseases, it may be possible to discontinue treatment before or shortly after conception. However, in some cases the benefits of treatment and concerns for disease flares in pregnancy have warranted continued treatment during pregnancy. Because of the relatively long half-life of these medications, and theoretical concerns for immune compromise of the infant following exposure in the latter two trimesters, some clinicians recommend discontinuation of treatment in the third trimester to avoid potentially prolonged infant exposure in the postpartum period. Currently ongoing controlled cohort studies for some of the TNF blocker medications will help to provide more definitive answers for clinicians and patients.

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Conception and course of eight pregnancies in five women on TNF blocker etanercept treatment

Cited by 21 publications

References 14 publications

Long-term safety and efficacy of etanercept in the treatment of ankylosing spondylitis

Long-term safety and efficacy of etanercept in the treatment of ankylosing spondylitis

Considerations on biologic agents in psoriasis with the new pregnancy lactation labeling rule

Emerging data on the use of anti‐tumor necrosis factor‐alpha medications in pregnancy

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