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Inicio Medicina Clínica (English Edition) Treatment with immunosuppressive and biologic drugs of pregnant women with syste...
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Vol. 147. Issue 8.
Pages 352-360 (October 2016)
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Vol. 147. Issue 8.
Pages 352-360 (October 2016)
Review
DOI: 10.1016/j.medcle.2016.11.006
Treatment with immunosuppressive and biologic drugs of pregnant women with systemic rheumatic or autoimmune disease
Tratamiento de las gestantes con enfermedades reumáticas o autoinmunitarias sistémicas con fármacos inmunodepresores y biológicos
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Jaume Alijotas-Reiga,
Corresponding author
, Enrique Esteve-Valverdea,b, Raquel Ferrer-Oliverasc
a Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Departamento de Medicina, Facultad de Medicina, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
b Servicio de Medicina Interna, Althaia, Xarxa Assistencial de Manresa, Manresa, Barcelona, Spain
c Servicio de Obstetricia y Ginecología, Fundació-Hospital del Esperit Sant, Santa Coloma de Gramanet, Barcelona, Spain
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Tables (6)
Table 1. Risk categories of immunosuppressive/immunomodulatory drugs during pregnancy according to the Food and Drug Administration.
Table 2. Considerations for using antirheumatic/immunosuppressants before and during pregnancy and lactation as recommended by the European League Against Rheumatism.
Table 3. Compatibility of antirheumatic/immunosuppressive drugs during pregnancy and lactation.
Table 4. Experience in the use of tumour necrosis factor inhibitors during pregnancy.
Table 5. Points to consider in family planning and pregnancy in patients with rheumatic/autoimmune diseases.
Table 6. Summary of biological drugs safety during pregnancy.
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Abstract

Rheumatic and systemic autoimmune diseases occur in women and, to a lesser degree, men of reproductive age. These disorders have to be clinically nonactive before conception, which is usually only possible after anti-inflammatory and immunosuppressive treatment. We must be alert since 50% of pregnancies are unplanned. Physicians should know the embryo-foetal toxicity of these drugs during pregnancy and lactation. This January 2016-updated review allows us to conclude that the majority of immunosuppressives available – anti-TNF inhibitors included – can be used before and during pregnancy, with the exception of cyclophosphamide, methotrexate, mycophenolate and leflunomide. Lactation is permitted with all drugs except methotrexate, leflunomide, mycophenolate and cyclophosphamide. Although data on abatacept, belimumab, rituximab, tocilizumab and anakinra are scant, preliminary reports agree on their safety during pregnancy and, probably, lactation. Cyclophosphamide and sulfasalazine apart, no negative effects on sperm quality, or embryo-foetal anomalies in men treated with immunosuppressives have been described.

Keywords:
Anti-inflammatory drugs
Anti-TNF-α
Biologics
Pregnancy
Adverse effects
Autoimmune diseases
Immunosuppressive
Lactation
Resumen

Las enfermedades reumáticas y autoinmunitarias afectan a mujeres y, en menor medida, también a hombres en edad fértil. Estas deben estar sin actividad clínica antes de la concepción, lo que suele conseguirse con fármacos inmunodepresores/antiinflamatorios. Un 50% de los embarazos en este colectivo no serán planificados. Los profesionales debemos conocer los efectos embrio/fetotóxicos de estos fármacos, así como sus consecuencias negativas sobre la gestación y la lactancia. Esta revisión actualizada hasta enero de 2016 permite concluir que la mayoría de los inmunodepresores disponibles, incluidos los inhibidores del TNF, se pueden utilizar antes y durante la gestación, con la excepción de ciclofosfamida, metotrexato, micofenolato y leflunomida. Se puede lactar exceptuando si se usa metotrexato, leflunomida, micofenolato y ciclofosfamida. Parece que abatacept, belimumab, rituximab, tocilizumab y anakinra son seguros durante la gestación y la lactancia. Exceptuando ciclofosfamida y sulfasalazina, no se han comunicado efectos sobre la calidad espermática ni un aumento de embriofetopatías en hombres tratados con inmunodepresores.

Palabras clave:
Antiinflammatorios
Anti-TNF-α
Biológicos
Embarazo
Efectos adversos
Enfermedades autoinmunitarias
Inmunodepresores
Lactancia

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