The use of biologics for autoimmune rheumatic diseases in fertility and pregnancy

Soh, May Ching; Moretto, Marcelo

doi:10.1177/1753495x19841799

Cited by 10 publications

(10 citation statements)

References 92 publications

(102 reference statements)

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“…Almost 50% of the patients continued the medication during the third trimester of pregnancy and a third of them until the time of delivery, and there was no increased risk of neonatal infection or infections during the first year of life [ 133 ]. Live vaccines are contraindicated in the first six months of life, especially BCG vaccine (Bacillus Calmette–Guérin) [ 134 ].…”

Section: Pathological Transfer Of Igg—biological Therapy In Pregnamentioning

confidence: 99%

Benefits and Risks of IgG Transplacental Transfer

et al. 2020

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Maternal passage of immunoglobulin G (IgG) is an important passive mechanism for protecting the infant while the neonatal immune system is still immature and ineffective. IgG is the only antibody class capable of crossing the histological layers of the placenta by attaching to the neonatal Fc receptor expressed at the level of syncytiotrophoblasts, and it offers protection against neonatal infectious pathogens. In pregnant women with autoimmune or alloimmune disorders, or in those requiring certain types of biological therapy, transplacental passage of abnormal antibodies may cause fetal or neonatal harm. In this review, we will discuss the physiological mechanisms and benefits of transplacental transfer of maternal antibodies as well as pathological maternal situations where this system is hijacked, potentially leading to adverse neonatal outcomes.

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Section: Pathological Transfer Of Igg—biological Therapy In Pregnamentioning

confidence: 99%

Benefits and Risks of IgG Transplacental Transfer

et al. 2020

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“…Before week 14 of pregnancy, biological drug molecules enter the foetus through passive diffusion and only insignificant volumes reach the foetus during embryogenesis (first 12 weeks of pregnancy). However, from the second trimester, the crossing of biological drugs is facilitated by an increased expression of trophoblast Fc receptors, and IgG transport is most intense in the third trimester of pregnancy, as a result of which neonatal IgG1 levels are often higher than maternal levels [32][33][34]. TNF-α inhibitors (etanercept, infliximab, adalimumab, golimumab and certolizumab pegol) are the most researched biological agents in terms of use by pregnant women.…”

Section: Discussionmentioning

confidence: 99%

The use of biological drugs in psoriasis patients prior to pregnancy, during pregnancy and lactation: a review of current clinical guidelines

Owczarek¹,

Walecka²,

Lesiak³

et al. 2020

pdia

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Introduction Information on the possibility of using biological drugs in psoriasis patients planning to conceive, patients who are pregnant or during lactation is limited. Aim Presenting recommendations published in clinical guidelines regarding the use of biological drugs – adalimumab, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab, and ustekinumab, by psoriasis patients in the period of planning pregnancy, during pregnancy or during lactation. Material and methods The paper was based on a comprehensive review of over 40 websites of HTA agencies, dermatological associations worldwide and medical databases (PubMed, Embase), the objective of which was to identify clinical guidelines relating to biological treatment of women of childbearing potential, published after 2018, which used GRADE – a system for rating the quality of a body of evidence. Findings Certolizumab pegol is recommended in women who are planning to conceive. Furthermore, guidelines indicate other TNF-α inhibitors as possible treatment. Certolizumab pegol is also recommended as first-line treatment in pregnant patients. Furthermore, for trimesters 2 and 3, guidelines allow using other TNF-α inhibitors. Treatment with secukinumab and ustekinumab should be discontinued when planning pregnancy or when pregnancy was diagnosed. Biological treatment during pregnancy and lactation (continuation or initiation of treatment) can be used only after an analysis of risks and benefits has been conducted. Conclusions TNF-α inhibitors seem to be the safest and most researched biological drugs used in psoriasis treatment of patients planning to conceive, during pregnancy or lactation. Given its non-existent or minimal placental permeability, most likely the safest alternative is certolizumab pegol.

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“…All rights reserved. Case series and registry data suggest no increased rate of congenital abnormalities [84][85][86][87] Case series and registry data suggests no increased rate of spontaneous abortions [84][85][86][87] NA Animal studies suggest no increased risk of malformation in survivors and one human case report showed no adverse neonatal outcome 91 Animal studies suggest a non-dose-related increase in spontaneous miscarriages and neonatal death 91 NA IMMUNO MODULATORS Anakinra Animal studies and human case reports suggest no increased risk of structural defects [92][93][94] Case series suggests no increased risk of fetal loss or preterm birth NA No human data in lactation. Probably compatible based on large molecular weight.…”

Section: Namentioning

confidence: 99%

Pregnancy and COVID‐19: pharmacologic considerations

D’Souza

Ashraf

Rowe

et al. 2021

Ultrasound in Obstet & Gyne

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Medline, Embase, the Cochrane databases, CINAHL and Scopus were searched from inception until May 14, 2020 using MeSH terms and free text search terms related to "coronavirus infections", "pregnancy", "breastfeeding". This was supplemented with targeted searches of general medical and obstetric journals for publications related to routine, off-label, and investigational medications used in COVID-19 patients either for symptomatic relief or in the context of clinical trials, and discussions with international experts. In addition, we reviewed product monographs of all drugs, and conducted targeted literature searches involving the use of each drug in pregnant women. Finally, clinical practice recommendations were summarized from pregnancy guidelines of international societies and ongoing trials were reviewed from three clinical trial registries-www.clinicaltrials.gov, Australian New Zealand Clinical Trials Registry (ANZCTR) and the World Health Organization International Clinical Trials Registry Platform (ICTRP). Given the limited experience with the management of COVID-19, research letters, editorials, commentaries, opinion pieces and special communications were included. No language restrictions were applied.

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The use of biologics for autoimmune rheumatic diseases in fertility and pregnancy

Cited by 10 publications

References 92 publications

Benefits and Risks of IgG Transplacental Transfer

Benefits and Risks of IgG Transplacental Transfer

The use of biological drugs in psoriasis patients prior to pregnancy, during pregnancy and lactation: a review of current clinical guidelines

Pregnancy and COVID‐19: pharmacologic considerations

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