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Treatment with biologics of pregnant patients with rheumatic diseases

Østensen, Monika; Förger, Frauke

Current Opinion in Rheumatology: May 2011 - Volume 23 - Issue 3 - p 293–298
doi: 10.1097/BOR.0b013e328344a732
Clinical therapeutics: Edited by Gerd Burmester and Thomas Dorner

Objective: Due to limited human pregnancy experience safety issues in regard to children exposed antenatally to biological drugs are still under debate. A survey of new published experience on biological agents during pregnancy is necessary to assist clinicians with adequate counseling and management of patients who desire children.

Recent findings: No controlled study has been published on use of TNFα inhibitors, rituximab, abatacept, tocilizumab or anakinra in pregnancy during the years 2009–2010. New case reports confirm that all monoclonal antibodies expose the child to the full adult dose when administered in late pregnancy with a risk for adverse effects in the newborn and perinatally. Data from a drug registry show that preconceptional and early first-trimester use of rituximab appears to confer no serious side effect to the child. Case reports on abatacept, tocilizumab or anakinra in pregnancy are not conclusive.

Summary: Differences in molecular structure of TNFα inhibitors may turn out to favor the use of agents that are not complete monoclonal antibodies in women who consider pregnancy. The very limited experience with abatacept, tocilizumab or anakinra in pregnancy allows no statement as to their compatibility with pregnancy. At present use of biological agents throughout pregnancy cannot be recommended.

Pregnancy Research Unit, Department of Rheumatology, Clinical Immunology and Allergology, University Hospital and University of Berne, Berne, Switzerland

Correspondence to Professor Monika Østensen, Pregnancy Research Unit, Department of Rheumatology and Clinical Immunology and Allergy, University of Bern, CH-3010 Bern, Switzerland Tel: +47 38 398707; fax: +41 31 632 2600; e-mail: monika.ostensen@gmail.com

© 2011 Lippincott Williams & Wilkins, Inc.