The use of biologics and small molecules in pregnant patients with rheumatic diseases
- 29 September 2018
- journal article
- review article
- Published by Informa UK Limited in Expert Review of Clinical Pharmacology
- Vol. 11 (10), 987-998
- https://doi.org/10.1080/17512433.2018.1525293
Abstract
Introduction: Biological agents have radically changed the prognosis of rheumatic patients. Current evidence demonstrates that tight disease control during pregnancy is mandatory to minimize adverse outcome risk. As the new therapeutic tools are pivotal to maintain appropriate disease activity, it is timely to review available evidence about the safety of biologics and small molecules in pregnancy. Areas covered: A comprehensive literature review has been performed, reporting available data about the passage into breast milk, rate of pregnancy loss and fetal malformations, and long-term complications due to in utero exposure to biological agents and small molecules. Expert commentary: Data about the safety of agents against tumor necrosis factor in pregnancy are reassuring. Even rituximab, tocilizumab, belimumab, ustekinumab, secukinumab, and abatacept have not been associated with an increased rate of fetal abnormalities or adverse pregnancy outcome. Experience with small molecules is too small to draw any conclusion. Even if further data are warranted to define the possible long-term effects of in utero biologic exposure on the infant immune system development, it is reasonable to speculate that in the next future the use of biologics during pregnancy will continue to expand, at least when maternal benefit justifies the potential risk to the fetus.Keywords
This publication has 89 references indexed in Scilit:
- Placental Transfer of Anti–Tumor Necrosis Factor Agents in Pregnant Patients With Inflammatory Bowel DiseaseClinical Gastroenterology and Hepatology, 2013
- Effects of Discontinuing Anti–Tumor Necrosis Factor Therapy During Pregnancy on the Course of Inflammatory Bowel Disease and Neonatal ExposureClinical Gastroenterology and Hepatology, 2013
- Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug useRheumatology, 2011
- Pregnancy outcomes after maternal exposure to rituximabBlood, 2011
- Development in the cynomolgus macaque following administration of ustekinumab, a human anti‐il‐12/23p40 monoclonal antibody, during pregnancy and lactationBirth Defects Research Part B: Developmental and Reproductive Toxicology, 2010
- Developmental and peri-postnatal study in cynomolgus monkeys with belimumab, a monoclonal antibody directed against B-lymphocyte stimulatorReproductive Toxicology, 2009
- Blocking Interleukin‐1 in Rheumatic DiseasesAnnals of the New York Academy of Sciences, 2009
- Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: Results of a national prospective studyArthritis & Rheumatism, 2009
- A Safety Assessment of Tumor Necrosis Factor Antagonists During Pregnancy: A Review of the Food and Drug Administration DatabaseThe Journal of Rheumatology, 2009
- Anti-CD20 treatment depletes B-cells in blood and lymphatic tissue of cynomolgus monkeysTransplant Immunology, 2003