Document Detail


Effects of Discontinuing Anti-Tumor Necrosis Factor Therapy During Pregnancy on the Course of Inflammatory Bowel Disease and Neonatal Exposure.
MedLine Citation:
PMID:  23103819     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND & AIMS: We assessed the course of inflammatory bowel disease (IBD) among pregnant women who stopped taking anti-tumor necrosis factor (TNF) agents. We also analyzed levels of anti-TNF agents in cord blood samples. METHODS: We followed 31 pregnancies in 28 women with IBD, between April 2006 and April 2011, who were treated with anti-TNF agents (18 received infliximab, 13 received adalimumab) during pregnancy. We used ELISAs to measure levels of anti-TNF agents in cord blood collected from 18 newborns (12 whose mothers took infliximab and 6 whose mothers took adalimumab). RESULTS: Among the patients taking infliximab, 12 (71%) discontinued treatment before gestational week 30; all patients remained in remission. All the patients taking adalimumab discontinued treatment before gestational week 30; 2 patients had relapses of IBD. There were 28 live births, 1 miscarriage among patients taking infliximab (at gestational week 6), and 2 miscarriages among patients taking adalimumab (at weeks 6 and 8); there were no congenital malformations. The mean cord blood level of infliximab was 6.4±1.6 μg/mL; it was significantly lower among women who received the drug 10 weeks or less before delivery (2.8±1.1 μg/mL) than those who received infliximab closer to delivery (10±2.3 μg/mL; P=.02). Adalimumab was detected in 5 samples of cord blood (mean concentration, 1.7±0.4 μg/ml); 1 cord blood sample, from a woman who discontinued the treatment at gestational week 22, had an undetectable level of the drug. CONCLUSION: Discontinuation of anti-TNF therapy appears to be safe for pregnant women with quiescent IBD. However, these drugs are still detected in cord blood samples.
Authors:
Zuzana Zelinkova; Cokkie van der Ent; Karlien F Bruin; Onno van Baalen; Hestia G Vermeulen; Herman J T Smalbraak; Rob J Ouwendijk; Aad C Hoek; Sjoerd D van der Werf; Ernst J Kuipers; C Janneke van der Woude;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-25
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  -     ISSN:  1542-7714     ISO Abbreviation:  Clin. Gastroenterol. Hepatol.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Gastroenterology and Hepatology, ERASMUS MC, Rotterdam. Electronic address: z.zelinkova@erasmusmc.nl.
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