Exposure to thiopurine drugs through breast milk is low based on metabolite concentrations in mother‐infant pairs

Gardiner, Sharon J.; Gearry, Richard B.; Roberts, Rebecca; Mei, Zhang; Barclay, Murray L.; Begg, Evan J.

doi:10.1111/j.1365-2125.2006.02639.x

Cited by 104 publications

(62 citation statements)

References 15 publications

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“…55 Some authors have determined infant exposure to 6-thioguanine and 6-methylmercaptopurine nucleotides during maternal use of azathioprine in breast-feeding in 4 women (all had the wildtype TPMT genotype). 56 Neither 6-thioguanine nor 6-methylmercaptopurine was detected in any of the infants. These data suggest that azathioprine may be safe during breast-feeding, at least in patients with the wildtype TPMT genotype (which is the case of 90% of Caucasian patients).…”

Section: Azathioprine/mercaptopurinementioning

confidence: 96%

Safety of immunomodulators and biologics for the treatment of inflammatory bowel disease during pregnancy and breast-feeding

Gisbert

2010

Inflammatory Bowel Diseases

123

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The aim of this article is to critically review available data regarding the safety of immunomodulators and biological therapies during pregnancy and breast-feeding in women with inflammatory bowel disease. Methotrexate and thalidomide can cause congenital anomalies and are contraindicated during pregnancy (and breast-feeding). Although thiopurines have a Food and Drug Administration (FDA) rating D, available data suggest that these drugs are safe and well tolerated during pregnancy. Although traditionally women receiving azathioprine or mercaptopurine have been discouraged from breast-feeding because of theoretical potential risks, it seems that these drugs may be safe in this scenario. Treatment with cyclosporine for steroid-refractory ulcerative colitis (UC) during pregnancy can be considered safe and effective, and the use of this drug should be considered in cases of severe UC as a means of avoiding urgent surgery. Breast-feeding is contraindicated for patients receiving cyclosporine. Biological therapies appear to be safe in pregnancy, as no increased risk of malformations has been demonstrated. Therefore, the limited clinical results available suggest that the benefits of infliximab and adalimumab in attaining response and maintaining remission in pregnant patients might outweigh the theoretical risks of drug exposure to the fetus. Stopping therapy in the third trimester may be considered, as it seems that transplacental transfer of infliximab is low prior to this. Certolizumab differs from infliximab and adalimumab in that it is a Fab fragment of an antitumor necrosis factor alpha monoclonal antibody, and therefore it may not be necessary to stop certolizumab in the third trimester. The use of infliximab is probably compatible with breast-feeding.

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Section: Azathioprine/mercaptopurinementioning

confidence: 96%

Safety of immunomodulators and biologics for the treatment of inflammatory bowel disease during pregnancy and breast-feeding

Gisbert

2010

Inflammatory Bowel Diseases

123

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“…Expert opinion differs regarding the use of azathioprine and 6-MP during lactation, but recent data support the view that these drugs may be prescribed on an individual basis and with caution during breastfeeding, as they are transmitted at very low levels in breast milk [74,75,76,77]. 6-Thioguanine concentration measurement offers a valuable means of objectively assessing infant exposure.…”

Section: Resultsmentioning

confidence: 99%

Pregnancy and Breastfeeding in Patients with Crohn’s Disease

et al. 2007

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Crohn’s disease commonly affects women of childbearing age. Available data on Crohn’s disease and pregnancy show that women with Crohn’s disease can expect to conceive successfully, carry to term and deliver a healthy baby. Control of disease activity before conception and during pregnancy is critical, to optimize both maternal and fetal health. Generally speaking, pharmacological therapy for Crohn’s disease during pregnancy is similar to pharmacological therapy for nonpregnant patients. Patients maintained in remission by way of pharmacological therapy should continue it throughout their pregnancy. Sulfasalazine, mesalazine and corticosteroids are safe, azathioprine and 6-mercaptopurine are reasonably safe with few discordant data, infliximab seems safe as well, whereas methotrexate is contraindicated during pregnancy. During breastfeeding, mesalazine and prednisone are considered safe, azathioprine/6-mercaptopurine, budesonide and infliximab probably safe and methotrexate is contraindicated.

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“…Терапия АЗА часто комбинировалась с приемом метилпреднизолона или ЦсА. Дети имели нормальные скорость роста, психомоторное развитие и показатели крови, частота инфекций у них не повыша-лась [64,[76][77][78].…”

Section: лекарства с потенциальным но недоказанным риском для грудноunclassified

Rheumatoid Arthritis and Pregnancy

Кошелева¹,

Matianova²

2014

rsp

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Ревматоидный артрит (РА) обычно начинается в том возрасте, когда вопрос материнства для многих жен-щин уже решен, однако он может дебютировать в детском и подростковом возрасте. Кроме того, в послед-ние годы прослеживается тенденция планирования беременности женщинами в более зрелом возрасте, что диктует необходимость обсуждения проблемы гестации при данном заболевании. Изучение механизмов вли-яния беременности на развитие РА как в период гестации, так и в отдаленные сроки имеет важное теорети-ческое и практическое значение. Результаты таких исследований могут быть использованы при разработке новых методов лечения РА и тактики ведения больных в период беременности и лактации. В статье приведе-ны данные литературы о фертильности при РА, влиянии беременности на активность РА и последнего на те-чение и исходы гестации, представлены современные воззрения на лактацию и применение оральных конт-рацептивов при РА. Особое внимание уделено лекарственной терапии беременных и кормящих женщин с РА: подробно рассмотрены группы антиревматических препаратов в соответствии с безопасностью или по-тенциальным риском их применения. Предложены терапевтический алгоритм и рекомендации по планиро-ванию беременности и наблюдению за пациентками с РА в период гестации. Ключевые слова: ревматоидный артрит; беременность; фертильность; лактация; лекарственная терапия. Для ссылки: Кошелева НМ, Матьянова ЕВ. Ревматоидный артрит и беременность. Научно-практическая ревматология. 2014;52(6):589-599. RHEUMATOID ARTHRITIS AND PREGNANCYKosheleva N.M., Matyanova E.V.Rheumatoid arthritis (RA) generally starts at the age when many women have already become mothers; however, it may occur in childhood or adolescence. Furthermore, there has been recently a women's tendency to plan pregnacy for a more mature age, which necessitates a discussion about gestation in this disease. Investigation of mechanisms pregnancy can influence the development of RA both in the gestation and long-term periods is of important theoretical and practical value. The results of these investigations may be used to develop new treatments for RA and management tactics for patients during pregnancy and lactation. The paper gives the data available in the literature on fertility in RA, impact of pregnancy on its activity and that of RA on the course and outcomes of gestation, as well as current ideas on lactation and use of oral contraceptives in RA. Particular attention is given to drug therapy in pregnant and breastfeeding women with RA: groups of anti-rheumatic drugs are considered in detail in relation to the safety of or a potential risk from their use. A therapeutic algorithm and recommendations for pregnancy planning and a follow-up of patients with RA during gestation are proposed.

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Exposure to thiopurine drugs through breast milk is low based on metabolite concentrations in mother‐infant pairs

Abstract: AimsTo determine infant exposure to 6-thioguanine and 6-methylmercaptopurine nucleotides (6-TGN and 6-MMPN, respectively) during maternal use of azathioprine in breastfeeding. MethodsMother-infant pairs provided blood for determination of 6-TGN and 6-MMPN concentrations, and TPMT genotype.

Cited by 104 publications

References 15 publications

Safety of immunomodulators and biologics for the treatment of inflammatory bowel disease during pregnancy and breast-feeding

Safety of immunomodulators and biologics for the treatment of inflammatory bowel disease during pregnancy and breast-feeding

Pregnancy and Breastfeeding in Patients with Crohn’s Disease

Rheumatoid Arthritis and Pregnancy

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