Assisted fertilization with at term pregnancies in two patients with severe rheumatoid arthritis while in treatment with etanercept
DOI:
https://doi.org/10.31053/1853.0605.v76.n1.21959Keywords:
etanercept, in vitro fertilization, rheumatoid arthritisAbstract
Introduction: There are numerous reports of patients with rheumatoid arthritis (RA) who became pregnant while on treatment with etanercept. In spite of being formally contraindicated during pregnancy and lactation its discontinuation in cases of women with severe RA is no longer recommended since an increase in congenital malformations nor perinatal complications has not been reported. There are few data on the success or failure of pregnancies achieved by assisted fertilization in patients with RA treated with etanercept. Methods: Two cases of severe RA under etanercept treatment and assisted fertilization are described. Results: After 4 failed attempts both patients became pregnant. They finally arrived at term without obstetric or perinatal complications. No congenital malformations nor infectious complications of the newborns occurred. Conclusion: The risk-benefit profile of etanercept in severe RA patients has been changing with postmarketing surveillance. If there is clinical indication, the benefit of not stopping etanercept during assited fertilization and pregnancy should be evaluated.
Downloads
References
Jawajeer D, Zhu JL, Nohr AE and Olsen J. Time to pregnancy among women with rheumatoid arthritis. Arthritis Rheum 2011; 63:1517-21
Brouwer J, Hazes JM, Laven JS, and Dolhain RJ. Fertility in women with rheumatoid arthritis: influences of disease activity and medication. Ann Rheum Dis 2015; 74:1836-41
Hazes JM, Coulie PG, Geenen V, Vermeire S, Carbonnel F, et al. Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use. Rheumatology 2011; 50:1955-68
Alijotas-Reig J, Esteve-Valverde E, Ferrer-Oliveras R, Llurba E, and Gris JM. Tumor Necrosis Factor-Alpha and Pregnancy: Focus on Biologics. An Updated and Comprehensive Review. Clinic Rev Allerg Immunol. 2017; 53: 40-53
Sanmartí R, García-Rodríguez S, Álvaro-Gracia JM, Andreu JL, Balsa A, et al. Actualización 2014 del Documento de Consenso de la Sociedad Española de Reumatología sobre el uso de terapias biológicas en la artritis reumatoide. Reumatol Clin. 2015; 11: 279–94
Götestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 2016; 75:795–810
Roux CH, Brocq O, Breuil V, Albert C and Euller-Ziegler L. Pregnancy in rheumatology patients exposed to anti-tumour necrosis factor (TNF)- therapy. Rheumatology 2007; 46: 695–98
Siwetz M, Blaschitz A , El-Heliebi A , Hiden U , Desoye G, et al. TNF-? alters the inflammatory secretion profile of human first trimester placenta. Laboratory Investigation. 2016; 96: 428–38
Alijotas-Reig J, Llurba E, Gris JM. Potentiating maternal immune tolerance in pregnancy: A new challenging role for regulatory T cells. Placenta 2014; 35 241-48
Winger EE, Reed JL. Treatment with tumor necrosis factor inhibitors and intravenous immunoglobulin improves live birth rates in women with recurrent spontaneous abortion. Am J Reprod Immunol 2008; 60: 8-16
Winger EE, Reed JL, Ashoush S, et al. Treatment with adalimumab (Humira) and intravenous immunoglobulin improves pregnancy rates in women undergoing IVF. An J Reprod Immunol 2009; 61: 113-20
Flint, J., Panchal S, Hurrel A, Van De Venne M, Gayed M, et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology 2016; 55:1693-7
Berthelsen BG, Fjeldsøe-Nielsen H, Nielsen CT, Hellmuth E. Etanercept concentrations in maternal serum, umbilical cord serum, breast milk and child serum during breastfeeding. Rheumatology 2010; 49: 2225–7
Carter JD, Valeriano J, Vasey FB. Tumor necrosis factor-alpha inhibition and VATER association: a causal relationship. J Rheumatol 2006; 33: 1014–7
Porter ML, Lockwood SJ, y Kimball AB. Update on biologic safety for patients with psoriasis during pregnancy. International Journal of Women's Dermatology. 2017; 3: 21–5
Downloads
Additional Files
Published
Issue
Section
License
Copyright (c) 2019 Universidad Nacional de Córdoba
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The generation of derivative works is allowed as long as it is not done for commercial purposes. The original work may not be used for commercial purposes.