Pregnancy and the use of TNF-α inhibitors for psoriasis

[Fred]

This study looked at the use of TNF-α inhibitors for psoriasis and pregnancy, The aim of this study was to evaluate the risk of major birth defects, spontaneous abortion, preterm birth and reduced birth weight after first trimester exposure to Humira (adalimumab) Remicade (infliximab) Enbrel (etanercept) Cimzia (certolizumab pegol) and Simponi (golimumab)

Quote:

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Aims:
TNF-α inhibitors are considered relatively safe in pregnancy but experience is still limited. The aim of this study was to evaluate the risk of major birth defects, spontaneous abortion, preterm birth and reduced birth weight after first trimester exposure to TNF-α inhibitors.

Methods:
Pregnancy outcomes of women on adalimumab, infliximab, etanercept, certolizumab pegol or golimumab were evaluated in a prospective observational cohort study and compared with outcomes of a non-exposed random sample. The samples were drawn from pregnancies identified by institutes collaborating in the European Network of Teratology Information Services.

Results:
In total, 495 exposed and 1532 comparison pregnancies were contributed from nine countries. The risk of major birth defects was increased in the exposed (5.0%) compared with the non-exposed group (1.5%; adjusted odds ratio (ORadj) 2.2, 95% CI 1.0, 4.8). The risk of preterm birth was increased (17.6%; ORadj 1.69, 95% CI 1.1, 2.5), but not the risk of spontaneous abortion (16.2%; adjusted hazard ratio [HRadj] 1.06, 95% CI 0.7, 1.7). Birth weights adjusted for gestational age and sex were significantly lower in the exposed group compared to the non-exposed cohort (P = 0.02). As a diseased comparison group was not possible to ascertain, the influence of disease and treatment on birth weight and preterm birth could not be differentiated.

Conclusions:
TNF-α inhibitors may carry a risk of adverse pregnancy outcome of moderate clinical relevance. Considering the impact of insufficiently controlled autoimmune disease on the mother and the unborn child, TNF-α inhibitors may nevertheless be a treatment option in women with severe disease refractory to established immunomodulatory drugs.

Source: onlinelibrary.wiley.com

*Early view, no funding known.

[jiml]

Now that's a worthwhile study in my opinion So the advice is still if thinking of getting pregnant it's safer to get off the bio drugs because there is some evidence that it may reduce birth weight and may contribute to premature births, and increase the risk of birth defects.
So for young women thinking of starting families better to let nature take its course for the period of the pregnancy and probably some time before if the baby is planned.
Did the study go on to the period after the birth for breastfeeding mums?

[Fred]

Now that's a worthwhile study in my opinion So the advice is still if thinking of getting pregnant it's safer to get off the bio drugs because there is some evidence that it may reduce birth weight and may contribute to premature births, and increase the risk of birth defects.
So for young women thinking of starting families better to let nature take its course for the period of the pregnancy and probably some time before if the baby is planned.

That's the way I have understood it.

Did the study go on to the period after the birth for breastfeeding mums?

Nope that's all I have for you, it's an early view so there could be more later but I think it would have been mentioned if there was.

[jiml]

Thanks again Fred for publishing all these studies it helps us all stay up to date with the current thinking on the disease and its treatments

[Fred]

Thanks again Fred for publishing all these studies it helps us all stay up to date with the current thinking on the disease and its treatments  

You're welcome Jim, but I do have a team of little teeny weeny roving reporters and a giant troll to help me out.  

Sorry I've gone

Lunch time.

[AmandaL]

Biologic's seem to come up better in studies on pregnancy and treatment against immunosuppressents. I would have thought as the biologic was stronger, they would be worse?

[Fred]

Biologic's seem to come up better in studies on pregnancy and treatment against immunosuppressents.  I would have thought as the biologic was stronger, they would be worse?

Interesting thought. But my theory would be that as the bio's are based on a living thing they would be better, whereas something like methotrexate for example we know is a poison and is used for ectopic pregnancy's.