The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Ankylosing Spondylitis Resource Center
    • Gout Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Prenatal TNF Inhibitor Exposure Not Linked to Serious Infections

Prenatal TNF Inhibitor Exposure Not Linked to Serious Infections

May 29, 2018 • By Anne Harding

  • Tweet
  • Email
Print-Friendly Version / Save PDF

NEW YORK (Reuters Health)—Children of women with rheumatoid arthritis (RA) who are exposed to tumor necrosis factor-alpha inhibitors (TNFis) in the womb are not at markedly increased risk of serious infections, new findings suggest.

You Might Also Like
  • TNFi Exposure in Utero
  • TNF Blocking Drugs Persist in Infants after Exposure In-Utero
  • Increased Risk of Serious Infections During Early Anti-TNF Treatment

“It’s reassuring for mothers who need to take these medications during pregnancy,” Evelyne Vinet, MD, of McGill University Health Center in Montreal, Canada, tells Reuters Health by phone. Nevertheless, she adds, physicians caring for pregnant RA patients should continue to follow best-practice guidelines on discontinuing certain TNFis well before delivery.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Twenty percent of pregnant women with RA are prescribed TNFi medications, Dr. Vinet and her colleagues note in Arthritis & Rheumatology, online May 17. Animal studies have suggested that fetal exposure to the drugs is safe, they add, but most of these medications do cross the placenta.1

Cord blood levels of infliximab and adalimumab can be well over maternal blood levels (160% and 150%, respectively), while passage to the fetus is lowest for etanercept and certolizumab, with median cord blood levels of 4% to 7% and less than 0.25%, respectively, in cord blood compared to maternal levels.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

In the wake of a 2010 case report of an infant exposed to infliximab prenatally who died of disseminated tuberculosis after receiving a Bacillus Calmette-Guerin vaccine, concerns were raised that TNFi exposure could lead to immunosuppression, the researchers note. Based on these concerns, the European League Against Rheumatism recommends infliximab and adalimumab be stopped before 20 weeks’ gestation and etanercept before 31-32 weeks, while certolizumab can be taken throughout pregnancy.

The researchers used 2011–2015 U.S. claim data on patients with commercial insurance through an employer to compare 2,989 RA offspring to 14,596 controls. In the RA group, 12.7% were exposed to TNFi prenatally, 4.5% were exposed during preconception, and 82.8% were not exposed.

Serious infections developed in 2% of offspring in the RA group during their first year of life, while 1.9% of offspring in the non-RA group had serious infections.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

TNFi-exposed children had a 3.2% risk of serious infection. The risk was 3.2% for those exposed in the third trimester, and 1.5% for those exposed before conception.

Multivariate analyses did not indicate an increased risk of serious infections in TNFi-exposed children compared with the controls, or for preconception exposure.

“The OR estimates for serious infections in RA offspring exposed to TNFi during pregnancy versus unexposed RA offspring were fairly wide and precluded a definitive conclusion, (OR 1.4, 95% CI 0.7, 2.8), as were the results when we restricted TNFi exposure to the third trimester versus unexposed offspring,” the authors state.

Offspring exposed to infliximab showed a trend toward increased risk of serious infections compared to infants exposed to other TNFi agents.

Acute bronchiolitis due to respiratory syncytial virus was the most common serious infection in all three groups, accounting for about one-third of all serious infections in each group. There were no cases of tuberculosis in exposed or unexposed RA offspring.

Although the findings could not confirm an increased risk of TNFi drugs overall, Dr. Vinet notes, “we could not exclude a differential risk according to specific TNFi characteristics, with infliximab potentially resulting in a three-fold increase in the risk of serious infections compared with other TNFis.”


Reference

  1. Vinet É, De Moura C, Pineau CA, et al. Serious infections in rheumatoid arthritis offspring exposed to tumour necrosis factor α inhibitors: Cohort study. Arthritis Rheumatol. 2018 May 17. doi: 10.1002/art.40536. [Epub ahead of print]

Pages: 1 2 | Multi-Page

Filed Under: DMARDs & Immunosuppressives, Drug Updates Tagged With: infants, pregnancy, Rheumatoid Arthritis (RA), tumor necrosis factor (TNF) inhibitors

You Might Also Like:
  • TNFi Exposure in Utero
  • TNF Blocking Drugs Persist in Infants after Exposure In-Utero
  • Increased Risk of Serious Infections During Early Anti-TNF Treatment
  • Paternal Methotrexate Exposure Not Tied to Adverse Pregnancy Outcomes

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2021 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.