Infliximab concentrations in the milk of nursing mothers with inflammatory bowel disease

Grosen, Anne; Julsgaard, Mette; Kelsen, Jens; Christensen, Lisbet Ambrosius

doi:10.1016/j.crohns.2013.09.003

Cited by 25 publications

(18 citation statements)

References 4 publications

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“…Breastfeeding did not affect anti-TNF clearance, adding evidence to the lack of any significant transfer of drug to the breast milk. [22][23][24] Because the proportion of lactating women has increased during the past 2 decades, these results underpin the advice to women to continue breastfeeding on anti-TNF treatment. 25,26 Most women continued treatment into the third trimester, based on the clinical evaluation by the physician and reflecting the severe phenotype of the cohort.…”

Section: Discussionmentioning

confidence: 99%

Concentrations of Adalimumab and Infliximab in Mothers and Newborns, and Effects on Infection

et al. 2016

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In a prospective study of infants born to mothers who received anti-TNF agents during pregnancy, we detected the drugs until 12 months of age. There was an inverse correlation between the time from last exposure during pregnancy and drug concentration in the umbilical cord. Infliximab was cleared more slowly than adalimumab from the infants. The combination of an anti-TNF agent and thiopurine therapy during pregnancy increased the relative risk for infant infections almost 3-fold compared with anti-TNF monotherapy. Live vaccines therefore should be avoided for up to 1 year unless drug clearance is documented, and pregnant women should be educated on the risks of anti-TNF use.

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Section: Discussionmentioning

confidence: 99%

Concentrations of Adalimumab and Infliximab in Mothers and Newborns, and Effects on Infection

et al. 2016

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“…CZP is a monovalent Fab fragment lacking the Fc region required for transplacental transport by the FcRn, therefore it is very low or undetectable in cord blood 19 . IFX and ADA levels in breast milk are very low (<1% of maternal plasma levels), and the small amount transferred through breast milk does not appear to affect the time it takes for these drugs to become undetectable in the infant circulation 17 , 21 – 23 . Similarly, thiopurine metabolites are low or undetectable in breast milk and the overall dose to the infant is <1% of therapeutic dosing 24 .…”

Section: Introductionmentioning

confidence: 99%

Anti-TNF and thiopurine therapy in pregnant IBD patients does not significantly alter a panel of B-cell and T-cell subsets in 1-year-old infants

Kattah

Milush

Burt

et al. 2018

Clinical and Translational Gastroenterology

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ObjectivesInfants exposed to combination therapy with anti-tumor necrosis factor (anti-TNF) agents and thiopurines may exhibit increased infections at 1 year of age compared to unexposed infants. We hypothesized that this increased risk of infection is due to abnormal development of the newborn immune system.MethodsWe immunophenotyped B-cell and T-cell subsets using multiparameter flow cytometry in 1-year-old infants whose mothers were exposed to therapeutic agents for IBD. We analyzed samples from infants exposed to infliximab (IFX) or adalimumab (ADA) monotherapy (IFX/ADA, n = 11), certolizumab pegol (CZP) monotherapy (CZP, n = 4), IFX or ADA plus thiopurine combination therapy (IFX/ADA + IM, n = 4), and CZP plus thiopurine combination therapy (CZP + IM, n = 2).ResultsPercentages of B cells, CD4+ T helper cells, T regulatory cells (Tregs), and CD8+ cytotoxic T cells, were similar among the groups. Infants exposed to combination therapy (IFX/ADA + IM) exhibited trends toward fewer CD27+ B cells, switched memory B cells, plasmablasts, interferon gamma (IFNγ)-producing CD4+ and CD8+ T cells, and CCR5+CD4+ T cells, but these did not reach statistical significance.ConclusionsMultiparameter immunophenotyping of major B-cell and T-cell subsets suggests that the adaptive newborn immune system develops largely unaltered after exposure to combination therapy as compared to anti-TNF monotherapy.

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“…However, since the neonate may be exposed to anti-TNF medication and it has been detected in infant blood up to 6 months of age, it is recommended that infants exposed to anti-TNF therapy in utero avoid being given live vaccines until after 6 months of age [ 1 , 20 ]. Studies have shown nil to minimal levels of infliximab and adalimumab in the breast milk and no significant adverse events have been reported in breastfeeding infants whose mothers take these drugs [ 38 , 50 – 54 ]. It is thought that any detectable levels in the neonate after delivery may be due to placental transfer during pregnancy [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown nil to minimal levels of infliximab and adalimumab in the breast milk and no significant adverse events have been reported in breastfeeding infants whose mothers take these drugs [ 38 , 50 – 54 ]. It is thought that any detectable levels in the neonate after delivery may be due to placental transfer during pregnancy [ 54 ]. There was a clear lack of knowledge regarding the use of infliximab and adalimumab among physician respondents in this study.…”

Section: Discussionmentioning

confidence: 99%

Management of Inflammatory Bowel Disease during Pregnancy and Breastfeeding Varies Widely: A Need for Further Education

Huang

Chang

Kroeker

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

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Background. Inflammatory bowel disease (IBD) affects patients in their young reproductive years. Women with IBD require maintenance therapies during pregnancy and breastfeeding. However, physician management of IBD during pregnancy and breastfeeding has not been well characterized. Objective. To characterize physician perceptions and management of IBD during pregnancy and breastfeeding. Methods. A cross-sectional survey of Canadian physicians who are involved in the care of women with IBD was conducted. The survey included multiple-choice and Likert scale questions about perceptions and practice patterns regarding the management of IBD during pregnancy and breastfeeding. Results. 183 practicing physicians completed the questionnaire: 97/183 (53.0%) gastroenterologists; 75/183 (41.0%) general practitioners; and 11/183 (6.0%) other physicians. Almost half (87/183, 47.5%) of the physicians felt comfortable managing pregnant IBD patients. For specified IBD medications, proportions of physicians who indicated they would continue them during pregnancy were as follows: sulfasalazine, 47.4%; oral mesalamine, 67.0%; topical mesalamine, 70.3%; oral prednisone, 68.0%; topical prednisone, 78.0%; oral budesonide, 61.6%; topical budesonide, 75.0%; ciprofloxacin, 15.3%; metronidazole, 31.4%; azathioprine, 57.1%; methotrexate, 2.8%; infliximab, 55.6%; adalimumab, 78.1%. Similar proportions of physicians would continue these medications during breastfeeding. A higher proportion of gastroenterologists than nongastroenterologists indicated appropriate use of these IBD medications during pregnancy and breastfeeding. Conclusions. Physician management of IBD during pregnancy and breastfeeding varies widely. Relative to other physicians, responses of gastroenterologists more frequently reflected best practices pertaining to medications for control of IBD during pregnancy and breastfeeding. There is a need for further education regarding the management of IBD during pregnancy and breastfeeding.

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Infliximab concentrations in the milk of nursing mothers with inflammatory bowel disease

Cited by 25 publications

References 4 publications

Concentrations of Adalimumab and Infliximab in Mothers and Newborns, and Effects on Infection

Concentrations of Adalimumab and Infliximab in Mothers and Newborns, and Effects on Infection

Anti-TNF and thiopurine therapy in pregnant IBD patients does not significantly alter a panel of B-cell and T-cell subsets in 1-year-old infants

Management of Inflammatory Bowel Disease during Pregnancy and Breastfeeding Varies Widely: A Need for Further Education

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