Pregnancy and the use of biologics
Jeffrey M. Weinberg, MD
November 13, 2007
Question:
A 32-year-old female patient who has had chronic moderate psoriasis since age 22 had success with etanercept for the past 18 months. She is now trying to get pregnant, but she is concerned about remaining on her current therapy. She is also concerned about her disease worsening if she discontinues therapy. Can she continue with etanercept while trying to conceive and during pregnancy? Answer:
Pregnancy and the use of biologics presents a very interesting dilemma. The conservative answer is that it is always preferable to avoid the use of systemic agents in pregnancy. On the other hand, biologics have been used safely in pregnant women, and anti -tumor necrosis factor (TNF)-alpha therapies are considered category B drugs for pregnancy.
Roux et al1 recently reviewed their experience of anti–TNF-alpha use in pregnancy and also reviewed the international literature. They concluded that, to date, there is no evidence that TNF-alpha antagonists are associated with embryo toxicity, teratogenicity, or increased pregnancy loss. However, caution should be taken when anti-TNF agents are used during pregnancy, as experience in humans is still extremely limited. They noted that large registries will be necessary before firm conclusions can be drawn.
My recommendation would be to proceed with caution and carefully evaluate the benefit-risk ratio. Although I would not generally recommend continued therapy, I would try to ascertain the patient’s preference. If a patient wishes to remain on biologic therapy, I would consult with the patient’s obstetrician and make a joint decision. Further information from ongoing registries will shed more light on this issue.
References
1. Roux CH, Brocq O, Breuil V, et al. Pregnancy in rheumatology patients exposed to anti-tomour necrosis factor (TNF)-alpha therapy. Rheumatology (Oxford). 2007;46:695-698.
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