Drug Insight:: anti-tumor necrosis factor therapy for inflammatory arthropathies during reproduction, pregnancy and lactation

被引:35
作者
Skomsvoll, Johan F.
Wallenius, Marianne
Koksvik, Hege S.
Rodevand, Erik
Salvesen, Kjell A.
Spigset, Olav
Kvien, Tore K.
机构
[1] Univ Trondheim Hosp, Dept Obstet, Trondheim, Norway
[2] Univ Trondheim Hosp, Dept Clin Pharmacol, Trondheim, Norway
[3] Univ Trondheim Hosp, Dept Rheumatol, Trondheim, Norway
[4] Norwegian Univ Sci & Technol, N-7034 Trondheim, Norway
[5] Univ Oslo, Oslo, Norway
[6] Diakonhjemmet Hosp, Dept Rheumatol, Oslo, Norway
来源
NATURE CLINICAL PRACTICE RHEUMATOLOGY | 2007年 / 3卷 / 03期
关键词
ankylosing spondylitis; anti-TNF therapy; lactation; pregnancy; rheumatoid arthritis;
D O I
10.1038/ncprheum0426
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Tumor necrosis factor (TNF) antagonists are widely used to reduce disease activity and joint damage, and to improve health-related quality of life in patients suffering from rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis. To date, no increased risk of embryotoxicity or teratogenicity, or adverse pregnancy outcome (such as birth defects, premature birth, and low birth weight) has been reported in patients with inflammatory arthropathies treated with anti-TNF therapy, compared with the general population. However, the available data are limited, and methotrexate, which is commonly used in combination with anti-TNF drugs, is teratogenic. Until more data are available, no firm conclusions can be reached regarding the safety of anti-TNF therapy in pregnancy. Nevertheless, in selected cases where there is high disease activity, anti-TNF therapy might be recommended, depending on the results of individual risk-benefit analyses. Fully informed consent from the mother is needed in such cases. Anti-TNF agents are not usually used during lactation, although the risk of toxicity is probably negligible.
引用
收藏
页码:156 / 164
页数:9
相关论文
共 62 条
[1]  
Barrett JH, 2000, ARTHRITIS RHEUM, V43, P1010, DOI 10.1002/1529-0131(200005)43:5<1010::AID-ANR8>3.0.CO
[2]  
2-O
[3]  
Barrett JH, 1999, ARTHRITIS RHEUM, V42, P1219, DOI 10.1002/1529-0131(199906)42:6<1219::AID-ANR19>3.0.CO
[4]  
2-G
[5]   The PREMIER study - A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment [J].
Breedveld, FC ;
Weisman, MH ;
Kavanaugh, AF ;
Cohen, SB ;
Pavelka, K ;
van Vollenhoven, R ;
Sharp, J ;
Perez, JL ;
Spencer-Green, GT .
ARTHRITIS AND RHEUMATISM, 2006, 54 (01) :26-37
[6]  
Briggs G, 2005, DRUGS PREGNANCY LACT
[7]  
Carter JD, 2006, J RHEUMATOL, V33, P1014
[8]  
Chakravarty EF, 2003, J RHEUMATOL, V30, P241
[9]   Human pregnancy safety for agents used to treat rheumatoid arthritis: adequacy of available information and strategies for developing post-marketing data [J].
Chambers, Christina D. ;
Tutuncu, Zuhre N. ;
Johnson, Diana ;
Jones, Kenneth L. .
ARTHRITIS RESEARCH & THERAPY, 2006, 8 (04)
[10]   Mechanisms of disease: Cytokine pathways and joint inflammation in rheumatoid arthritis. [J].
Choy, EHS ;
Panayi, GS .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 344 (12) :907-916