RESEARCH - Update on safety during pregnancy of biological and some immunosuppressive anti-rheumatic drugs

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Rheumatology (Oxford). 2008 Jun;47 Suppl 3:iii28-31.

Update on safety during pregnancy of biological agents and some

immunosuppressive anti-rheumatic drugs.

Østensen M, Lockshin M, Doria A, Valesini G, Meroni P, Gordon C,

Brucato A, Tincani A.

Department of Rheumatology and Clinical Immunology and Allergology,

University Hospital of Bern, CH-3010 Bern, Switzerland.

A consensus paper concerning the interaction of anti-rheumatic drugs

and reproduction was published in 2006, representing data collected

during the year 2004 and 2005. Because of an increasing use of

biological agents in women of fertile age, the information was updated

for the years 2006 and 2007. Experts disagree whether TNF-inhibitors

should be stopped as soon as pregnancy is recognized or may be

continued throughout pregnancy. Pregnancy experience with abatacept

and rituximab is still too limited to prove their safety for the

developing fetus. They must be withdrawn before a planned pregnancy.

LEF has not been proven to be a human teratogen. Registries of

transplant recipients have shown that cyclosporin (CsA) and tacrolimus

do not increase the rate of congenital anomalies, whereas

mycophenolate mofetil (MMF) clearly carries a risk for congenital

anomalies. Prophylactic withdrawal of drugs before pregnancy is

mandatory for abatacept, rituximab, LEF and MMF. Data remain

insufficient for gonadal toxicity of immunosuppressive drugs in men

and for excretion of these drugs in human breast milk.

PMID: 18504282

http://www.ncbi.nlm.nih.gov/pubmed/18504282

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