Intentional infliximab use during pregnancy for induction or maintenance of remission in Crohn's disease

Abstract

SUMMARYAim: To study the effects of infliximab on pregnancy and foetal outcome. Methods: We conducted a retrospective chart review of women with Crohn's disease treated intentionally with infliximab during pregnancy. The primary outcome measure was the occurrence of congenital malformations. Secondary outcome measures were the rate of premature birth, low-birth weight, small for gestational age infants, intrauterine growth retardation and caesarean section.

Is safety infliximab during pregnancy in patients with inflammatory bowel disease?

“…There are series of cases where no congenital anomalies have been described. In the series of Mahadevan (14), which is the most widely notified to date, ten pregnant women with Crohn's disease were treated with IFX. Eight of them received IFX as a maintenance treatment, in other words, they were already being treated with the drug and two of them had this reviewed during gestation for the first time due to the worsening of their disease.…”

Management of inflammatory bowel disease in pregnancy

“…Most of the women in the study stopped INF upon learning of their pregnancy, so exposure was primarily during conception and the first trimester [101]. Other smaller studies have been mixed, with one reporting all ten pregnancies studied ending in live births without congenital anomalies [102], while another study of 22 patients exposed to INF during the first trimester reported three spontaneous abortions, one missed abortion, one stillbirth at 36 weeks (from umbilical strangulation), two preterm births, three low-birthweight infants and no congenital malformations [103].…”

Treatment of inflammatory bowel disease and pregnancy: a review of the literature

“…Serum levels of infliximab can be found in newborns of mothers who used this medication during pregnancy (56) . What can explain this fact is the transplacental transfer of maternal antibodies in the first quarter, as it is an antibody of Class IgG (36) . In some reports found, this transfer does not seem to be harmful to the fetus (Table 1) and, similar to other maternal antibodies, infliximab has a half-life prolonged in the newly born (36) .…”

“…What can explain this fact is the transplacental transfer of maternal antibodies in the first quarter, as it is an antibody of Class IgG (36) . In some reports found, this transfer does not seem to be harmful to the fetus (Table 1) and, similar to other maternal antibodies, infliximab has a half-life prolonged in the newly born (36) . There is no evidence of excretion this drug in the mother's milk (54,56) .…”

“…Infliximab is a chimeric monoclonal antibody against tumor necrosis factor alpha (TNF-α), considered effective for both induction and for maintenance of clinical remission of the CD (36) . The initial dose, administered intravenously, is 5 mg/kg at week 0, 2 and 6 for induction of response and maintained this dose every 8 weeks for maintenance of remission.…”