UPMC Inflammatory Bowel Disease Center, UPMC Presbyterian Hospital, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburg School of Medicine, Pittsburgh, PA 15213, USA.
Curr Drug Targets. 2010 Feb;11(2):234-41. doi: 10.2174/138945010790309885.
The incidence of inflammatory bowel disease (IBD; Crohn's disease, ulcerative colitis) is highest during the peak reproductive years, hence the increased concern with the safety of IBD drugs during pregnancy. Over the past 11 years, anti-TNF-alpha antibody therapy has emerged as a treatment approach for refractory IBD patients who have failed to achieve or maintain remission with corticosteroids and immunomodulator agents. The TNF-alpha inhibitors (anti-TNFs; infliximab, adalimumab, certolizumab pegol) have proven successful in inducing and maintaining remission of moderate-to-severe IBD, but recommendations for the use of these compounds during pregnancy have lacked consensus. Balanced against the potential risk of these drugs on the fetus is the well-established fact that high disease activity has been found to poorly affect pregnancy outcomes in IBD, and the potential use of anti-TNF agents may control disease flare and severity during pregnancy. Concerns regarding the effect of anti-TNFs on the pregnancy and fetus have been assuaged by registry data which has demonstrated an overall positive safety record. Both the U.S. Food and Drug Administration and the European Crohn's and Colitis Organization categorize anti-TNF agents as safe during pregnancy. New knowledge regarding the physiologic timing of placental transfer of therapeutic antibody subclasses and pegylated antibody fragments from the mother into the fetus has also helped to allay concerns. This review will examine the present state of knowledge regarding the use of anti-TNFs in pregnant women with IBD.
炎症性肠病（IBD；克罗恩病、溃疡性结肠炎）的发病率在生育高峰期最高，因此人们越来越关注 IBD 药物在怀孕期间的安全性。在过去的 11 年中，抗 TNF-α 抗体疗法已成为皮质类固醇和免疫调节剂治疗失败的难治性 IBD 患者的治疗方法。TNF-α 抑制剂（抗 TNFs；英夫利昔单抗、阿达木单抗、培塞利珠单抗）已被证明可成功诱导和维持中重度 IBD 的缓解，但关于这些化合物在怀孕期间使用的建议缺乏共识。权衡这些药物对胎儿的潜在风险，与疾病活动度高会对 IBD 的妊娠结局产生不良影响这一既定事实相平衡，以及抗 TNF 药物的潜在用途可能控制妊娠期间的疾病发作和严重程度。关于抗 TNFs 对妊娠和胎儿影响的担忧已经被注册数据缓解，这些数据显示了总体上良好的安全性记录。美国食品和药物管理局和欧洲克罗恩病和结肠炎组织都将抗 TNF 药物归类为怀孕期间安全。关于治疗性抗体亚类和聚乙二醇化抗体片段从母体向胎儿转移的生理时间的新知识也有助于减轻担忧。这篇综述将探讨目前关于在患有 IBD 的孕妇中使用抗 TNFs 的知识状况。
