Stockholm, Sweden.
Helsinki, Finland.
Aliment Pharmacol Ther. 2020 Sep;52(5):843-854. doi: 10.1111/apt.15971. Epub 2020 Jul 24.
Most anti-tumour necrosis factor (anti-TNF) agents are transferred across the placenta and may increase paediatric susceptibility to infections.
To assess the risk of paediatric infections after maternal anti-TNF treatment.
Population-based cohort study in Denmark, Finland and Sweden 2006-2013 in which 1027 children born to women with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis or inflammatory bowel disease, treated with anti-TNF, and 9346 children to women with non-biologic systemic treatment, were compared to 1 617 886 children of the general population. Children were followed for 3 years.
Adjusted by maternal age, parity, smoking, body mass index, country and calendar year, the incidence rate ratios with 95% confidence interval (CI) for hospital admissions for infection in the first year were 1.43 (1.23-1.67) for anti-TNF and 1.14 (1.07-1.21) for non-biologic systemic treatment, and 1.29 (1.11-1.50) and 1.09 (1.02-1.15), respectively, when additionally adjusting for adverse birth outcomes. There was a slight increase in antibiotic prescriptions in the second year for anti-TNF, 1.19 (1.11-1.29), and for non-biologic systemic treatment, 1.10 (1.07-1.13). There was no difference among anti-TNF agents, treatment in the third trimester, or between mono/combination therapy with non-biologic systemic treatment.
Both anti-TNF and non-biologic systemic treatment were associated with an increased risk of paediatric infections. However, reassuringly, the increased risks were present regardless of treatment in the third trimester, or with combination treatment, and were not persistent during the first 3 years of life. Our findings may indicate a true risk, but could also be due to unadjusted confounding by disease severity and healthcare-seeking behaviour. This may in turn shift the risk-benefit equation towards continuation of treatment even in the third trimester.
大多数抗肿瘤坏死因子（anti-TNF）药物可穿过胎盘，并可能增加儿科患者感染的易感性。
评估母亲接受抗 TNF 治疗后儿科感染的风险。
这是一项丹麦、芬兰和瑞典的基于人群的队列研究，纳入了 2006 年至 2013 年间 1027 名患有类风湿关节炎、银屑病、银屑病关节炎、强直性脊柱炎或炎症性肠病的接受抗 TNF 治疗的女性所分娩的儿童，以及 9346 名接受非生物性系统性治疗的女性所分娩的儿童，并与普通人群的 1617886 名儿童进行比较。对儿童进行了 3 年的随访。
根据母亲的年龄、产次、吸烟、体重指数、国家和日历年份进行调整后，第 1 年因感染住院的发病率比值比（IRR）及其 95%置信区间（CI）为抗 TNF 组 1.43（1.23-1.67），非生物性系统性治疗组 1.14（1.07-1.21）；在进一步调整不良妊娠结局后，抗 TNF 组和非生物性系统性治疗组的第 2 年抗生素处方率分别为 1.29（1.11-1.50）和 1.09（1.02-1.15）。不同的抗 TNF 药物、第 3 孕期治疗以及非生物性系统性治疗的单药/联合治疗之间，并无差异。
抗 TNF 和非生物性系统性治疗均与儿科感染风险增加相关。然而，令人欣慰的是，这种风险的增加与第 3 孕期治疗或联合治疗无关，且在生命的前 3 年并不持续。我们的发现可能表明存在真正的风险，但也可能是由于疾病严重程度和医疗保健寻求行为的未经调整混杂因素所致。这可能会使风险效益比朝着即使在第 3 孕期也继续治疗的方向倾斜。
