Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands.
J Crohns Colitis. 2018 Jul 30;12(8):939-947. doi: 10.1093/ecco-jcc/jjy058.
Pregnancy guidelines for women with inflammatory bowel disease [IBD] provide recommendations regarding anti-TNF cessation during pregnancy, in order to limit foetal exposure. Although infliximab [IFX] leads to higher anti-TNF concentrations in cord blood than adalimumab [ADA], the recommendations are similar. We aimed to demonstrate the effect of anti-TNF cessation during pregnancy on foetal exposure, for IFX and ADA separately.
We conducted a prospective single-center cohort study. Women with IBD, using IFX or ADA, were followed-up during pregnancy. In case of sustained disease remission, anti-TNF was stopped in the third trimester. At the birth, the anti-TNF concentration was measured in the cord blood. A linear regression model was developed to demonstrate anti-TNF concentration in cord blood at birth. In addition, outcomes such as disease activity, pregnancy outcomes and 1-year health outcomes of infants were collected.
We included 131 pregnancies that resulted in a live birth [73 IFX, 58 ADA]. At birth, 94 cord blood samples were obtained [52 IFX, 42 ADA], showing significantly higher levels of IFX than ADA [p < 0.0001]. Anti-TNF type and stop week were used in the linear regression model. During the third trimester, IFX transportation over the placenta increased exponentially; however, ADA transportation was limited and increased in a linear fashion. Overall, health outcomes were comparable.
Our linear regression model shows that ADA may be continued longer during pregnancy, because transportation over the placenta is lower than for IFX. This may reduce relapse risk of the mother, without increasing foetal anti-TNF exposure.
针对炎症性肠病（IBD）女性患者，妊娠指南中建议在妊娠期间停止使用抗 TNF 药物，以减少胎儿暴露。尽管英夫利昔单抗（IFX）在脐血中的抗 TNF 浓度高于阿达木单抗（ADA），但建议是相似的。我们旨在分别证明 IFX 和 ADA 妊娠期间停止使用抗 TNF 药物对胎儿暴露的影响。
我们进行了一项前瞻性单中心队列研究。使用 IFX 或 ADA 的 IBD 女性在妊娠期间接受随访。如果疾病持续缓解，则在妊娠晚期停止使用抗 TNF 药物。在分娩时，测量脐血中的抗 TNF 浓度。建立线性回归模型以证明脐血中抗 TNF 浓度在出生时的情况。此外，还收集了疾病活动度、妊娠结局和婴儿 1 年健康结局等结局数据。
我们纳入了 131 例活产妊娠[73 例 IFX，58 例 ADA]。在分娩时，获得了 94 份脐血样本[52 份 IFX，42 份 ADA]，结果显示 IFX 的水平明显高于 ADA[P<0.0001]。线性回归模型中使用了抗 TNF 药物类型和停药周数。在妊娠晚期，IFX 通过胎盘转运呈指数增加；然而，ADA 转运有限，呈线性增加。总体而言，健康结局相当。
我们的线性回归模型表明，ADA 可能在妊娠期间可以更长时间继续使用，因为它通过胎盘的转运比 IFX 低。这可能会降低母亲的复发风险，而不会增加胎儿的抗 TNF 暴露。
