Division of Gastroenterology, Department of Medicine, University of California, San Francisco, California 94115, USA.
Clin Gastroenterol Hepatol. 2013 Mar;11(3):286-92; quiz e24. doi: 10.1016/j.cgh.2012.11.011. Epub 2012 Nov 28.
BACKGROUND & AIMS: Some women with inflammatory bowel disease require therapy with tumor necrosis factor (TNF) antagonists during pregnancy. It is not clear whether these drugs are transferred to the fetus via the placenta and then cleared, or whether structurally different TNF antagonists have different rates of transfer.
We studied 31 pregnant women with inflammatory bowel disease receiving infliximab (IFX, n = 11), adalimumab (ADA, n = 10), or certolizumab (CZP, n = 10). Serum concentrations of the drugs were measured at birth in the mother, infant, and in cord blood, and then monthly in the infant until the drugs were undetectable. Drug concentrations in the cord and the infant at birth were compared with those of the mother.
Concentrations of IFX and ADA, but not CZP, were higher in infants at birth and their cords than in their mothers. The levels of CZP in infants and their cords were less than 2 μg/mL. The median level of IFX in the cord was 160% that of the mother, the median level of ADA in the cord was 153% that of the mother, and the median level of CZP in the cord was 3.9% that of the mother. IFX and ADA could be detected in the infants for as long as 6 months. No congenital anomalies or serious complications were reported.
The TNF antagonists IFX and ADA are transferred across the placenta and can be detected in infants at birth; the drugs were detected in infants up to 6 months after birth. CZP has the lowest level of placental transfer, based on levels measured in cords and infants at birth, of the drugs tested.
一些患有炎症性肠病的女性在怀孕期间需要接受肿瘤坏死因子（TNF）拮抗剂治疗。目前尚不清楚这些药物是通过胎盘转移到胎儿体内然后清除，还是结构不同的 TNF 拮抗剂具有不同的转移率。
我们研究了 31 名接受英夫利昔单抗（IFX，n = 11）、阿达木单抗（ADA，n = 10）或 Certolizumab（CZP，n = 10）治疗的炎症性肠病孕妇。在母亲、婴儿和脐带血中测量出生时药物的血清浓度，然后每月在婴儿中测量，直到药物无法检测到。比较脐带和婴儿出生时的药物浓度与母亲的药物浓度。
IFX 和 ADA 的浓度，但不是 CZP 的浓度，在婴儿出生时及其脐带中的浓度高于母亲。婴儿和脐带中的 CZP 浓度均低于 2μg/ml。脐带中 IFX 的中位数水平为母亲的 160%，脐带中 ADA 的中位数水平为母亲的 153%，脐带中 CZP 的中位数水平为母亲的 3.9%。IFX 和 ADA 可在婴儿体内检测长达 6 个月。未报告先天性异常或严重并发症。
TNF 拮抗剂 IFX 和 ADA 通过胎盘转移，并可在出生时的婴儿中检测到；这些药物在婴儿出生后 6 个月内仍可检测到。根据检测到的脐带和婴儿出生时的水平，CZP 是转移率最低的药物。
