Certolizumab treatment during late pregnancy in patients with rheumatic diseases: Low drug levels in cord blood but possible risk for maternal infections. A case series of 13 patients


Autoria(s): Förger, Frauke; Zbinden, Astrid; Villiger, Peter
Data(s)

23/11/2015

Resumo

OBJECTIVE Due to reduction of immune-suppressive drugs, patients with rheumatic diseases can experience an increase in disease activity during pregnancy. In such cases, TNF-inhibitors may be prescribed. However, monoclonal antibodies with the Fc moiety are actively transported across the placenta, resulting in therapeutic drug levels in the newborn. As certolizumab (CZP) lacks the Fc moiety, it may bear a lower risk for the child. METHOD We report a case series of thirteen patients (5 with rheumatoid arthritis and 8 with spondyloarthritis) treated with CZP during late pregnancy to control disease activity. RESULT CZP measured in cord blood of eleven infants ranged between undetectable levels and 1μg/mL whereas the median CZP level of maternal plasma was 32.97μg/mL. Three women developed an infection during the third trimester, of whom one had a severe infection and one had an infection that resulted in a pre-term delivery. During the postpartum period, 6 patients remained on CZP while breastfeeding. CZP levels in the breast milk of two breastfeeding patients were undetectable. CONCLUSION The lack of the active transplacental transfer of CZP gives the possibility to treat inflammatory arthritis during late gestation without potential harm to the newborn. However, in pregnant women treated with TNF-inhibitors and prednisone, attention should be given to the increased susceptibility to infections, which might cause prematurity. CZP treatment can be continued while breastfeeding.

Formato

application/pdf

Identificador

http://boris.unibe.ch/80935/1/1-s2.0-S1297319X15002171-main.pdf

Förger, Frauke; Zbinden, Astrid; Villiger, Peter (2015). Certolizumab treatment during late pregnancy in patients with rheumatic diseases: Low drug levels in cord blood but possible risk for maternal infections. A case series of 13 patients. Joint bone spine, 83(3), pp. 341-343. Elsevier Masson SAS 10.1016/j.jbspin.2015.07.004 <http://dx.doi.org/10.1016/j.jbspin.2015.07.004>

doi:10.7892/boris.80935

info:doi:10.1016/j.jbspin.2015.07.004

info:pmid:26617214

urn:issn:1297-319X

Idioma(s)

eng

Publicador

Elsevier Masson SAS

Relação

http://boris.unibe.ch/80935/

Direitos

info:eu-repo/semantics/restrictedAccess

Fonte

Förger, Frauke; Zbinden, Astrid; Villiger, Peter (2015). Certolizumab treatment during late pregnancy in patients with rheumatic diseases: Low drug levels in cord blood but possible risk for maternal infections. A case series of 13 patients. Joint bone spine, 83(3), pp. 341-343. Elsevier Masson SAS 10.1016/j.jbspin.2015.07.004 <http://dx.doi.org/10.1016/j.jbspin.2015.07.004>

Palavras-Chave #610 Medicine & health
Tipo

info:eu-repo/semantics/article

info:eu-repo/semantics/publishedVersion

PeerReviewed