Pregnancy outcomes following exposure to abatacept during pregnancy

Kumar, Monica; Ray, Laura E.; Vemuri, Sudha; Simon, Teresa A.

doi:10.1016/j.semarthrit.2015.06.016

Cited by 59 publications

(55 citation statements)

References 28 publications

(36 reference statements)

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“…This is similar to what we have previously reported in which Orencia administration reduced fetal weight in our animal model of PE 19 . There is limited clinical data on the safety of Orencia during pregnancy, however what has been reported is that while there are some fetal abnormalities associated with exposure to Orencia they low risk to the fetus is believe to be outweighed by the benefit to the mother 37 . In our studies we did not see a decrease in fetal weight in the NP+Orencia group which suggests that the angiogenic imbalance in addition to Orencia might be causing the decrease in fetal weight as opposed to treatment of Orencia.…”

Section: Discussionmentioning

confidence: 99%

Inhibition of T‐cell activation attenuates hypertension,TNFα,IL‐17, and blood–brain barrier permeability in pregnant rats with angiogenic imbalance

Bean

Spencer

Bowles

et al. 2016

American J Rep Immunol

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Problem Angiogenic imbalance during pregnancy is associated with immune activation, hypertension, increased T cell infiltration, and neurological insults. Method of Study On gestational day (GD) 12 timed-pregnant rats were infused with anti-angiogenic factors sFlt-1 and sEndoglin (4.7 and 7μg/kg) to create HELLP syndrome via mini-osmotic pumps for 8 days, with a subset of these rats having Orencia (2mg/kg) infused on GD13. On GD19, blood brain barrier (BBB) permeability was evaluated via Evan’s Blue infusion, blood was collected for T cell measurements, inflammatory cytokine secretion. Brain tissues were also collected to examine inflammatory cytokine infiltration. Results T cell attenuation with Orencia decreased circulating CD4+ and CD8+ T cells, circulating TNFα and IL-17, BBB permeability and significantly decreased biochemical evidence of HELLP compared to untreated HELLP rats. Conclusions These data support the hypothesis that T cells have a critical role in contributing to the pathophysiology that is seen in angiogenic imbalance during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Inhibition of T‐cell activation attenuates hypertension,TNFα,IL‐17, and blood–brain barrier permeability in pregnant rats with angiogenic imbalance

Bean

Spencer

Bowles

et al. 2016

American J Rep Immunol

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“…The largest series of maternal exposure to abatacept is 151 pregnancies with 86 live births 75. In 59, the pregnancy resulted in an abortion, 40 spontaneous (over half of patients were also receiving MTX) and 19 elective.…”

Section: Woman With Ra Who Wants To Get Pregnantmentioning

confidence: 99%

“…Of ten men whose partners became pregnant while exposed to abatacept,75 nine pregnancies resulted in live births, and one ended as an elective abortion. There were no congenital abnormalities and no fetal deaths 75…”

Section: Male Patient With Ra Who Wants To Start a Familymentioning

confidence: 99%

Management of rheumatoid arthritis during pregnancy: challenges and solutions

Krause¹,

Makol²

2016

OARRR

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Rheumatoid arthritis, a chronic inflammatory autoimmune disease with significant physical disability, affects women three times more frequently than men, often in their childbearing years. Parenthood decisions can be challenging, often affected by perceptions of their disease state, health care needs, and complex pharmacological treatments. Many women struggle to find adequate information to guide them on pregnancy planning, lactation, and early parenting in relation to their chronic condition. The expanded availability and choice of pharmacotherapies have supported optimal disease control prior to conception and enhanced physical capabilities for women to successfully overcome the challenges of raising children but require a detailed understanding of their risks and safety in the setting of pregnancy and breastfeeding. This review outlines the various situational challenges faced by rheumatologists in providing care to men and women in the reproductive age group interested in starting a family. Up to date evidence-based solutions particularly focusing on the safe use of disease-modifying antirheumatic drugs and biologic response modifiers to assist rheumatologists in the care of pregnant and lactating women with RA are reviewed.

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“…7 We report herein the first 2 live births in 2 kidney transplant recipients exposed to belatacept and prednisone during pregnancy. There were 10 paternal-exposed pregnancies with no congenital malformations or fetal deaths.…”

Section: Discussionmentioning

confidence: 93%

Belatacept during pregnancy in renal transplant recipients: Two case reports

Combs

Kagan

Boelkins

et al. 2018

American Journal of Transplantation

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Impaired fertility is common among patients with chronic organ failure, including end-stage renal disease (ESRD). Women of childbearing age undergoing transplantation may experience rapid return of fertility. Pregnancy posttransplant presents numerous risks for the patient, fetus, and allograft. Maternal risks include hypertension and preeclampsia. Allograft risks include acute rejection and failure of the organ, and fetal risks include miscarriage, birth defects from immunosuppressants, premature delivery, and low birth weight. Belatacept, a selective T cell costimulation blocker, was approved for use in kidney transplant recipients in the United States in 2011. Little is known about the safety of belatacept during pregnancy in humans. We describe 2 cases of successful pregnancy and delivery with the use of belatacept-based immunosuppression. The Transplant Pregnancy Registry International (TPR) is a voluntary registry for transplant recipients who have had pregnancies or fathered a pregnancy posttransplant. To date, these 2 cases are the only known exposures to belatacept that have been reported to the TPR.

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Pregnancy outcomes following exposure to abatacept during pregnancy

Cited by 59 publications

References 28 publications

Inhibition of T‐cell activation attenuates hypertension,TNFα,IL‐17, and blood–brain barrier permeability in pregnant rats with angiogenic imbalance

Inhibition of T‐cell activation attenuates hypertension,TNFα,IL‐17, and blood–brain barrier permeability in pregnant rats with angiogenic imbalance

Management of rheumatoid arthritis during pregnancy: challenges and solutions

Belatacept during pregnancy in renal transplant recipients: Two case reports

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