Safety of intravitreal injection of ranibizumab in early pregnancy: a series of three cases

Fossum, P.; Couret, C.; Briend, B; Weber, Michel; Lagarce, Laurence

doi:10.1038/eye.2017.305

Cited by 14 publications

(16 citation statements)

References 4 publications

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“…The half-life of intravitreal bevacizumab in a human was estimated to be 6.7–10 d depending on the use of either a one-compartment model or two-compartment model[ 65 - 68 ], while the half-life of bevacizumab in human serum is 17–21 d, similar to that of other full-length antibodies. Intravitreal aflibercept has a half-life of 4.7 d in rabbits[ 69 ] and an estimated 9 d in humans based on the intermediate size of the molecule (between ranibizumab and bevacizumab), while bound aflibercept in human serum has a half-life of 18 d[ 70 ]. Table 1 summarizes the structural and pharmacokinetic characteristics of the four anti-VEGF drugs.…”

Section: Preparing For Dr Progression In Pregnant Diabeticsmentioning

confidence: 99%

“…Several studies on the use of ranibizumab and bevacizumab in pregnant women have been reported of which some have been summarized by Polizzi and Mahajan[ 31 ]. Most of the studies in pregnant women are case reports, and initial intravitreal ranibizumab was given either 8–17 wk post last menstrual period (LMP)[ 70 ] or in the third trimester[ 71 , 72 ]; all reported no complications.…”

Section: Preparing For Dr Progression In Pregnant Diabeticsmentioning

confidence: 99%

“…Despite these reports of spontaneous miscarriages and preeclampsia occurring after intravitreal anti-VEGF injections given within 13 wk of gestation, other reports did not find adverse events with injections given within the same time frame[ 70 , 74 , 75 , 77 , 78 , 80 , 81 ]; thus, it is uncertain whether anti-VEGF therapy played a role in these pregnancy losses, as the rate of spontaneous miscarriage is between 15% and 20%[ 84 ] and may increase to as high as 41% if maternal age is over 35 years[ 85 ]. There were no reports on pegaptanib and aflibercept being administered in pregnant women.…”

Section: Preparing For Dr Progression In Pregnant Diabeticsmentioning

confidence: 99%

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Review of the management of sight-threatening diabetic retinopathy during pregnancy

Choo¹,

Din²,

Azmi³

et al. 2021

WJD

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Diabetes mellitus (DM) is a noncommunicable disease reaching epidemic proportions around the world. It affects younger individuals, including women of childbearing age. Diabetes can cause diabetic retinopathy (DR), which is potentially sight threatening when severe nonproliferative DR (NPDR), proliferative DR (PDR), or sight-threatening diabetic macular oedema (STDME) develops. Pregnancy is an independent risk factor for the progression of DR. Baseline DR at the onset of pregnancy is an important indicator of progression, with up to 10% of women with baseline NPDR progressing to PDR. Progression to sight-threatening DR (STDR) during pregnancy causes distress to the patient and often necessitates ocular treatment, which may have a systemic effect. Management includes prepregnancy counselling and, when possible, conventional treatment prior to pregnancy. During pregnancy, closer follow-up is required for those with a long duration of DM, poor baseline control of blood sugar and blood pressure, and worse DR, as these are risk factors for progression to STDR. Conventional treatment with anti-vascular endothelial growth factor agents for STDME can potentially lead to foetal loss. Treatment with laser photocoagulation may be preferred, and surgery under general anaesthesia should be avoided. This review provides a management plan for STDR from the perspective of practising ophthalmologists. A review of strategies for maintaining the eyesight of diabetic women with STDR with emphasis on prepregnancy counselling and planning, monitoring and safe treatment during pregnancy, and management of complications is presented.

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Section: Preparing For Dr Progression In Pregnant Diabeticsmentioning

confidence: 99%

Section: Preparing For Dr Progression In Pregnant Diabeticsmentioning

confidence: 99%

Section: Preparing For Dr Progression In Pregnant Diabeticsmentioning

confidence: 99%

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Review of the management of sight-threatening diabetic retinopathy during pregnancy

Choo¹,

Din²,

Azmi³

et al. 2021

WJD

View full text Add to dashboard Cite

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“…Women of childbearing age are advised to wait 3 months after the last dose before conceiving. 18 For pregnant women who develop signficant macular oedema and are at risk of irreversible vision loss, ophthalmology review and counselling regarding the potential risks versus benefits is mandated. 19,20 If anti-VEGF drugs are to be used, then ranibizumab may be preferable to bevacizumab or aflibercept because it suppresses plasma VEGF levels to a lesser degree.…”

Section: Diabetic Eye Diseasementioning

confidence: 99%

Ocular manifestations of pregnancy and labour: from the innocuous to the sight threatening

Patil

Ellabban

Patil

et al. 2020

The Obstetric & Gynaecologis

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Pregnancy may precipitate several physiological changes that can have ocular consequences; many of these are innocuous and require little more than reassurance for the patient. There are uncommon instances of new sight-threatening pathology that necessitate a prompt approach. Pregnant women presenting to the ophthalmologist with ocular symptoms can cause concern because alternative differentials may need to be considered; and the potential teratogenic or fetotoxic effects of investigations or treatment mean that management decisions may, in some cases, differ to those of the nonpregnant patient. Learning objectives To be aware of both physiological and pathological ocular changes that may occur during pregnancy. To develop a greater understanding of investigations and management of ophthalmic and neuro-ophthalmic disorders in pregnancy. To develop an understanding of referral pathways, enabling an optimal outcome for both mother and baby.

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“…However, these studies did not specifically investigate patients with MFC and PIC, but noninfectious uveitis in general. Since anti-VEGF is considered to be potentially teratogenic and embryofetotoxic, treatment with intravitreal anti-VEGF injections is advised to be avoided in pregnancy, especially in the first trimester (Polizzi & Mahajan 2015;Peracha & Rosenfeld 2016;Fossum et al 2018). Therefore, it is of utmost importance to prohibit the development or reactivation of CNV during pregnancy in patients with MFC and PIC.…”

Section: Introductionmentioning

confidence: 99%

Idiopathic multifocal choroiditis and punctate inner choroidopathy: an evaluation in pregnancy

Groot

Huet

Bloemenkamp

et al. 2021

Acta Ophthalmologica

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Purpose To evaluate the clinical course of idiopathic multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC) and the efficacy and safety of treatment options during pregnancy. Methods Patients with MFC or PIC and a pregnancy in 2011–2019 from two academic centres were enrolled. For the most recent pregnancy, data on best‐corrected visual acuity (BCVA) before and after pregnancy, relapse rate in pregnancy and postpartum period and obstetric, maternal and neonatal outcomes were collected. Treatment regimens consisted of a wait‐and‐see regime and an immunosuppressive treatment regime with systemic corticosteroids and/or azathioprine, both combined with intravitreal antivascular endothelial growth factor injections when indicated. Results Sixteen women (26 affected eyes) were included. Median Snellen BCVA was 20/19 before pregnancy and 20/18 after delivery. In seven pregnancies a wait‐and‐see regime and in nine pregnancies an immunosuppressive treatment regime was carried out. Fourteen intravitreal anti‐VEGF injections were given in six pregnancies. The relapse rate during pregnancy was 44% and in the postpartum period 31%. Maternal/obstetrical and fetal complications occurred in 31% and 13% of the pregnancies, respectively. Fifteen healthy children were born and one pregnancy ended in a stillbirth in a patient with a complicated obstetrical history. One patient treated with azathioprine developed intrahepatic cholestasis of pregnancy (ICP). Conclusions Among women with MFC and PIC BCVA remained stable during pregnancy despite a relapse rate of 44% in pregnancy. No major maternal, obstetric and fetal complications occurred in pregnant patients treated with systemic corticosteroids, azathioprine or intravitreal anti‐VEGF injections, though one patient developed ICP while treated with azathioprine.

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Safety of intravitreal injection of ranibizumab in early pregnancy: a series of three cases

Cited by 14 publications

References 4 publications

Review of the management of sight-threatening diabetic retinopathy during pregnancy

Review of the management of sight-threatening diabetic retinopathy during pregnancy

Ocular manifestations of pregnancy and labour: from the innocuous to the sight threatening

Idiopathic multifocal choroiditis and punctate inner choroidopathy: an evaluation in pregnancy

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