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Scott HM, Mehta R, Branda ME, Hughes J, Kane SV, Girard S, Norgan AP, Theiler RN, Enninga EAL. Effect of Anti-TNF Biologic Exposure During Pregnancy on Villitis of Unknown Etiology Diagnoses in Patients with Autoimmune Disease. Reprod Sci 2024; 31:997-1005. [PMID: 37973775 PMCID: PMC10960686 DOI: 10.1007/s43032-023-01402-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
Tumor necrosis factor-α (TNF-α) antagonists are highly effective in controlling autoimmune diseases. This has led to speculation that they might also be useful in treating inflammatory placental conditions, such as chronic villitis of unknown etiology (VUE). VUE affects 10-15% of term placentas and is associated with recurrent fetal growth restriction (FGR) and pregnancy loss. We aimed to evaluate outcomes in patients with autoimmune diseases with and without anti-TNF-α biologic exposure during gestation. This retrospective cohort study compared pregnant women with autoimmune disease taking anti-TNF-α biologics (n = 89) to pregnant women with autoimmune disease but not taking a biologic (n = 53). We extracted data on all patients meeting our inclusion criteria over a 20-year period. Our primary outcome was the diagnosis of VUE by histology. Our secondary outcomes were maternal and neonatal complications such as preeclampsia, FGR, and neonatal intensive care admission. Kruskal-Wallis and chi-squared tests were performed as appropriate for statistical analysis. Maternal characteristics were comparable between groups, and there was no increase in adverse pregnancy outcomes based on anti-TNF-α treatment. Exposure to anti-TNF-α therapy had no significant effect on the incidence of VUE or other obstetric complications. Within the cohort exposed to anti-TNF-α biologics during pregnancy, the rate of VUE was 9.3%, which is comparable to the reported general population risk. Our data support the safety profile of biologic use in pregnancy.
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Affiliation(s)
- Hannah M Scott
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Ave. SW, Rochester, MN, 55905, USA
| | - Ramila Mehta
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Megan E Branda
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Sunanda V Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Sylvie Girard
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Ave. SW, Rochester, MN, 55905, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Andrew P Norgan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Ave. SW, Rochester, MN, 55905, USA
| | - Elizabeth Ann L Enninga
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Ave. SW, Rochester, MN, 55905, USA.
- Department of Immunology, Mayo Clinic, Rochester, MN, USA.
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Marshall NE, Blanton MB, Doratt BM, Malherbe DC, Rincon M, Messaoudi I. Monoclonal Antibody Therapy of Breastfeeding Patient Infected with SARS-CoV-2: A Case Report. Breastfeed Med 2023; 18:626-630. [PMID: 37615569 PMCID: PMC10460680 DOI: 10.1089/bfm.2023.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Introduction: Although safety data demonstrated the efficacy and effectiveness of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination for all individuals over 6 months of age, including pregnant and breastfeeding individuals, optimal treatment courses for symptomatic pregnant and lactating individuals infected with SARS-CoV-2 remain to be defined. Case Description: A coronavirus disease 2019 (COVID-19)-vaccinated breastfeeding woman received anti-SARS-CoV-2 monoclonal antibody treatment casirivimab-imdevimab 5 days after diagnosis of a symptomatic breakthrough SARS-CoV-2 infection. Results and Conclusions: The patient did not present with obvious defects in innate or adaptive cellular subsets, but compared with controls had minimal maternal antibody response to recommended pregnancy vaccinations including SARS-CoV-2 and tetanus, diphtheria, pertussis (TDaP). The outcome of the monoclonal antibody infusion treatment was favorable as it transiently increased SARS-CoV-2 antibody titers in plasma and human milk compartments.
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Affiliation(s)
- Nicole E. Marshall
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Madison B. Blanton
- Department of Microbiology, Immunology, and Molecular Genetics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Brianna M. Doratt
- Department of Microbiology, Immunology, and Molecular Genetics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Delphine C. Malherbe
- Department of Microbiology, Immunology, and Molecular Genetics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Monica Rincon
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Ilhem Messaoudi
- Department of Microbiology, Immunology, and Molecular Genetics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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Bennett A, Mamunes A, Kim M, Duley C, Garrett A, Annis K, Wagnon J, Dalal R, Scoville E, Beaulieu D, Schwartz D, Horst S. The Importance of Monitoring the Postpartum Period in Moderate to Severe Crohn's Disease. Inflamm Bowel Dis 2022; 28:409-414. [PMID: 33999196 DOI: 10.1093/ibd/izab104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Prior research demonstrates Crohn's disease patients often do well in pregnancy; however, less is known about the risk of flare in the postpartum period. METHODS A retrospective chart review was conducted at a tertiary care inflammatory bowel disease center. All pregnant women with Crohn's disease who were followed in the postpartum period, defined as 6 months after delivery, were included. Statistical analysis included χ 2 analysis, Wilcoxon rank sum test, and logistic regression analysis. The primary outcome of interest was rate of flare in the postpartum period. RESULTS There were 105 patients included in the study, with a majority (68%) on biologic medication during pregnancy. Thirty-one patients (30%) had a postpartum flare at a median of 9 weeks (range 2-24 weeks). Twenty-five patients (81%) had their postpartum flare managed in the outpatient setting with medications (only 4 of these patients required prednisone). 6 of 31 patients (19%) were hospitalized at a median of 4 weeks (range 2-26 weeks) after delivery, requiring intravenous corticosteroids or surgery. In multivariable regression, there was no significant increase in risk of postpartum flare with increasing maternal age, flare during pregnancy, or steroid or biologic use during pregnancy. Smoking during pregnancy increased risk of postpartum flare (odds ratio, 16.2 [1.72-152.94], P < 0.05). CONCLUSION In a cohort of Crohn's disease patients, 30% experienced a postpartum flare despite being on medical therapy, but most were able to be managed in the outpatient setting.
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Affiliation(s)
- Audrey Bennett
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Alexander Mamunes
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | | | - Caroline Duley
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Ailish Garrett
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Kim Annis
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Julianne Wagnon
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Robin Dalal
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Elizabeth Scoville
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Dawn Beaulieu
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - David Schwartz
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Sara Horst
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Primrose N, Johnston E. Prescribing for pregnancy: inflammatory bowel disease. Drug Ther Bull 2022; 60:24-28. [PMID: 35086899 DOI: 10.1136/dtb.2020.000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Inflammatory bowel diseases commonly present in young adulthood and it is estimated that up to one in 200 pregnant women have IBD. Key factors for successful pregnancy outcome are disease remission at the time of conception and optimal disease control during pregnancy, with active disease increasing the risk of adverse effects for both mother and baby. This article forms part of a series on prescribing for pregnancy and discusses the impact of IBD on pregnancy and the influence pregnancy may have on IBD. It highlights the importance of prepregnancy care and collaborative working between obstetric and gastroenterology specialties as well as focusing on prescribing before, during and after pregnancy, exploring treatment options for IBD which are evolving rapidly as new immunosuppressive agents emerge.
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Affiliation(s)
- Naomi Primrose
- Obstetrics and Gyanecology, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Emma Johnston
- Gastroenterology, West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Pham-Huy A, Top KA, Constantinescu C, Seow CH, El-Chaâr D. Utilisation et incidence des agents biologiques à base d’anticorps monoclonaux durant la grossesse. CMAJ 2021; 193:E1537-E1544. [PMID: 34607850 PMCID: PMC8568088 DOI: 10.1503/cmaj.202391-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Anne Pham-Huy
- Division d'infectiologie, immunologie et allergie (Pham-Huy), Hôpital pédiatrique de l'Est de l'Ontario; Faculté de médecine (Pham-Huy), Université d'Ottawa, Ottawa, Ont.; Centre de santé IWK, Division d'infectiologie, Centre canadien de vaccinologie (Top), Halifax, N.-É.; Faculté de médecine de l'Université de Calgary, Division d'infectiologie pédiatrique (Constantinescu); Division de gastro-entérologie et d'hépatologie (Seow), Départements de médecine et de sciences de la santé communautaire, Université de Calgary, Calgary, Alb.; Groupe de recherche OMNI de l'IRHO (El-Chaâr), Programme d'épidémiologie clinique; Service d'obstétrique, gynécologie et soins aux nouveau-nés (El-Chaâr), Hôpital d'Ottawa, Ottawa, Ont.
| | - Karina A Top
- Division d'infectiologie, immunologie et allergie (Pham-Huy), Hôpital pédiatrique de l'Est de l'Ontario; Faculté de médecine (Pham-Huy), Université d'Ottawa, Ottawa, Ont.; Centre de santé IWK, Division d'infectiologie, Centre canadien de vaccinologie (Top), Halifax, N.-É.; Faculté de médecine de l'Université de Calgary, Division d'infectiologie pédiatrique (Constantinescu); Division de gastro-entérologie et d'hépatologie (Seow), Départements de médecine et de sciences de la santé communautaire, Université de Calgary, Calgary, Alb.; Groupe de recherche OMNI de l'IRHO (El-Chaâr), Programme d'épidémiologie clinique; Service d'obstétrique, gynécologie et soins aux nouveau-nés (El-Chaâr), Hôpital d'Ottawa, Ottawa, Ont
| | - Cora Constantinescu
- Division d'infectiologie, immunologie et allergie (Pham-Huy), Hôpital pédiatrique de l'Est de l'Ontario; Faculté de médecine (Pham-Huy), Université d'Ottawa, Ottawa, Ont.; Centre de santé IWK, Division d'infectiologie, Centre canadien de vaccinologie (Top), Halifax, N.-É.; Faculté de médecine de l'Université de Calgary, Division d'infectiologie pédiatrique (Constantinescu); Division de gastro-entérologie et d'hépatologie (Seow), Départements de médecine et de sciences de la santé communautaire, Université de Calgary, Calgary, Alb.; Groupe de recherche OMNI de l'IRHO (El-Chaâr), Programme d'épidémiologie clinique; Service d'obstétrique, gynécologie et soins aux nouveau-nés (El-Chaâr), Hôpital d'Ottawa, Ottawa, Ont
| | - Cynthia H Seow
- Division d'infectiologie, immunologie et allergie (Pham-Huy), Hôpital pédiatrique de l'Est de l'Ontario; Faculté de médecine (Pham-Huy), Université d'Ottawa, Ottawa, Ont.; Centre de santé IWK, Division d'infectiologie, Centre canadien de vaccinologie (Top), Halifax, N.-É.; Faculté de médecine de l'Université de Calgary, Division d'infectiologie pédiatrique (Constantinescu); Division de gastro-entérologie et d'hépatologie (Seow), Départements de médecine et de sciences de la santé communautaire, Université de Calgary, Calgary, Alb.; Groupe de recherche OMNI de l'IRHO (El-Chaâr), Programme d'épidémiologie clinique; Service d'obstétrique, gynécologie et soins aux nouveau-nés (El-Chaâr), Hôpital d'Ottawa, Ottawa, Ont
| | - Darine El-Chaâr
- Division d'infectiologie, immunologie et allergie (Pham-Huy), Hôpital pédiatrique de l'Est de l'Ontario; Faculté de médecine (Pham-Huy), Université d'Ottawa, Ottawa, Ont.; Centre de santé IWK, Division d'infectiologie, Centre canadien de vaccinologie (Top), Halifax, N.-É.; Faculté de médecine de l'Université de Calgary, Division d'infectiologie pédiatrique (Constantinescu); Division de gastro-entérologie et d'hépatologie (Seow), Départements de médecine et de sciences de la santé communautaire, Université de Calgary, Calgary, Alb.; Groupe de recherche OMNI de l'IRHO (El-Chaâr), Programme d'épidémiologie clinique; Service d'obstétrique, gynécologie et soins aux nouveau-nés (El-Chaâr), Hôpital d'Ottawa, Ottawa, Ont
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Pham-Huy A, Top KA, Constantinescu C, Seow CH, El-Chaâr D. The use and impact of monoclonal antibody biologics during pregnancy. CMAJ 2021; 193:E1129-E1136. [PMID: 34312166 PMCID: PMC8321301 DOI: 10.1503/cmaj.202391] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Anne Pham-Huy
- Division of Infectious Diseases, Immunology and Allergy (Pham-Huy), Children's Hospital of Eastern Ontario; Faculty of Medicine (Pham-Huy), University of Ottawa, Ottawa, Ont.; IWK Health Centre, Division of Infectious Diseases, Canadian Center for Vaccinology (Top), Halifax, NS; University of Calgary Faculty of Medicine, Division of Pediatric Infectious Diseases (Constantinescu); Division of Gastroenterology and Hepatology (Seow), Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alta.; OHRI OMNI Research Group (El-Chaâr), Clinical Epidemiology Program; Department of Obstetrics, Gynecology and Newborn Care (El-Chaâr), Ottawa Hospital, Ottawa, Ont.
| | - Karina A Top
- Division of Infectious Diseases, Immunology and Allergy (Pham-Huy), Children's Hospital of Eastern Ontario; Faculty of Medicine (Pham-Huy), University of Ottawa, Ottawa, Ont.; IWK Health Centre, Division of Infectious Diseases, Canadian Center for Vaccinology (Top), Halifax, NS; University of Calgary Faculty of Medicine, Division of Pediatric Infectious Diseases (Constantinescu); Division of Gastroenterology and Hepatology (Seow), Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alta.; OHRI OMNI Research Group (El-Chaâr), Clinical Epidemiology Program; Department of Obstetrics, Gynecology and Newborn Care (El-Chaâr), Ottawa Hospital, Ottawa, Ont
| | - Cora Constantinescu
- Division of Infectious Diseases, Immunology and Allergy (Pham-Huy), Children's Hospital of Eastern Ontario; Faculty of Medicine (Pham-Huy), University of Ottawa, Ottawa, Ont.; IWK Health Centre, Division of Infectious Diseases, Canadian Center for Vaccinology (Top), Halifax, NS; University of Calgary Faculty of Medicine, Division of Pediatric Infectious Diseases (Constantinescu); Division of Gastroenterology and Hepatology (Seow), Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alta.; OHRI OMNI Research Group (El-Chaâr), Clinical Epidemiology Program; Department of Obstetrics, Gynecology and Newborn Care (El-Chaâr), Ottawa Hospital, Ottawa, Ont
| | - Cynthia H Seow
- Division of Infectious Diseases, Immunology and Allergy (Pham-Huy), Children's Hospital of Eastern Ontario; Faculty of Medicine (Pham-Huy), University of Ottawa, Ottawa, Ont.; IWK Health Centre, Division of Infectious Diseases, Canadian Center for Vaccinology (Top), Halifax, NS; University of Calgary Faculty of Medicine, Division of Pediatric Infectious Diseases (Constantinescu); Division of Gastroenterology and Hepatology (Seow), Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alta.; OHRI OMNI Research Group (El-Chaâr), Clinical Epidemiology Program; Department of Obstetrics, Gynecology and Newborn Care (El-Chaâr), Ottawa Hospital, Ottawa, Ont
| | - Darine El-Chaâr
- Division of Infectious Diseases, Immunology and Allergy (Pham-Huy), Children's Hospital of Eastern Ontario; Faculty of Medicine (Pham-Huy), University of Ottawa, Ottawa, Ont.; IWK Health Centre, Division of Infectious Diseases, Canadian Center for Vaccinology (Top), Halifax, NS; University of Calgary Faculty of Medicine, Division of Pediatric Infectious Diseases (Constantinescu); Division of Gastroenterology and Hepatology (Seow), Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alta.; OHRI OMNI Research Group (El-Chaâr), Clinical Epidemiology Program; Department of Obstetrics, Gynecology and Newborn Care (El-Chaâr), Ottawa Hospital, Ottawa, Ont
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The use of biological drugs in psoriasis patients prior to pregnancy, during pregnancy and lactation: a review of current clinical guidelines. Postepy Dermatol Alergol 2021; 37:821-830. [PMID: 33603597 PMCID: PMC7874874 DOI: 10.5114/ada.2020.102089] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/14/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction Information on the possibility of using biological drugs in psoriasis patients planning to conceive, patients who are pregnant or during lactation is limited. Aim Presenting recommendations published in clinical guidelines regarding the use of biological drugs – adalimumab, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab, and ustekinumab, by psoriasis patients in the period of planning pregnancy, during pregnancy or during lactation. Material and methods The paper was based on a comprehensive review of over 40 websites of HTA agencies, dermatological associations worldwide and medical databases (PubMed, Embase), the objective of which was to identify clinical guidelines relating to biological treatment of women of childbearing potential, published after 2018, which used GRADE – a system for rating the quality of a body of evidence. Findings Certolizumab pegol is recommended in women who are planning to conceive. Furthermore, guidelines indicate other TNF-α inhibitors as possible treatment. Certolizumab pegol is also recommended as first-line treatment in pregnant patients. Furthermore, for trimesters 2 and 3, guidelines allow using other TNF-α inhibitors. Treatment with secukinumab and ustekinumab should be discontinued when planning pregnancy or when pregnancy was diagnosed. Biological treatment during pregnancy and lactation (continuation or initiation of treatment) can be used only after an analysis of risks and benefits has been conducted. Conclusions TNF-α inhibitors seem to be the safest and most researched biological drugs used in psoriasis treatment of patients planning to conceive, during pregnancy or lactation. Given its non-existent or minimal placental permeability, most likely the safest alternative is certolizumab pegol.
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Tzanetakou V, Stergianou D, Giamarellos-Bourboulis EJ. Long-term safety of adalimumab for patients with moderate-to-severe hidradenitis suppurativa. Expert Opin Drug Saf 2020; 19:381-393. [PMID: 32098513 DOI: 10.1080/14740338.2020.1734560] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Hidradenitis suppurativa (HS) is a chronic debilitating inflammatory skin disorder that affects regions rich in apocrine glands. Although the etiology of HS is not clear, inflammatory cytokines, like tumor necrosis factor (TNF)-α, participate in pathogenesis. Adalimumab (ADA), a human IgG1 monoclonal antibody that selectively targets TNFα, is the only EMA/FDA-approved biologic agent available for the therapy of moderate-to-severe HS.Areas covered: A comprehensive literature search was conducted to present existing studies with an emphasis on the safety profile of ADA for the treatment of moderate-to-severe HS. ADA is prescribed for more than 15 years for varied indications and has improved the therapeutic outcomes of many diseases. Clinical trials and real-life safety data from ADA administration in HS were presented, with particular attention to special populations, such as children, elderly, and pregnant women.Expert opinion: Existing data advise for limited safety concerns with long-term ADA treatment provided that patients are thoroughly screened for infections, latent tuberculosis, and history of malignancy before the start of treatment.
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Affiliation(s)
- Vassiliki Tzanetakou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Stergianou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
Rotavirus (RV) is the leading cause of severe gastroenteritis in young children. However, because the incorporation of live-attenuated RV vaccines as part routine childhood immunization schedules, the rates of hospitalization from RV infections have decreased significantly across the globe. While RV vaccine safety and effectiveness have been well documented in the general population, there is controversy surrounding its use in preterm and immunocompromised infants. In this article, we review current research and consensus statements on the safety of the RV vaccine, the immunogenicity of the response and the potential for transmission and shedding of the virus postvaccination in both preterm infants and immunocompromised infants. RV vaccines are well tolerated in hospitalized preterm infants with no significant increase in nosocomial infections, gastrointestinal complications or feeding difficulties. In select immunocompromised infants (such as HIV-infected or HIV-exposed infants), RV vaccine administration did not increase the rate of adverse events. However, multiple case reports noted increased rates of adverse events in infants with severe combined immunodeficiency. The risk of viral shedding and transmission between vaccinated neonates and household contacts remain low and does not outweigh the benefit of vaccination.
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10
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Pham-Huy A, Sadarangani M, Huang V, Ostensen M, Castillo E, Troster SM, Vaudry W, Nguyen GC, Top KA. From mother to baby: antenatal exposure to monoclonal antibody biologics. Expert Rev Clin Immunol 2019; 15:221-229. [PMID: 30570400 DOI: 10.1080/1744666x.2019.1561282] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION More women with autoimmune and inflammatory conditions are being treated with monoclonal antibody biologics (mAbs) during their pregnancy, to maintain clinical remission. The use of anti-tumor necrosis factor alpha agents in pregnancy appears to be safe but less is known regarding other mAbs, such as anti-integrins and anti-cytokine agents. There are currently no comprehensive guidelines on how to manage the exposed infants. Areas covered: We review recent literature to assess the impact of mAbs on birth and early infant outcomes, including what is currently known about maternal and infant drug levels at birth and drug clearance in the infant. We describe the potential risks of infections and reported hematological and immunological effects of antenatal mAbs exposure on the infant and provide guidance on the management of the exposed infant. Expert opinion: Exposed infants should be monitored closely. Certain mAb exposures require specific testing and management. Safety monitoring should be done in a multidisciplinary approach and should include pediatric care providers. The current clinical experience with anti-tumor necrosis factor agents in pregnancy cannot be extrapolated to other mAbs. Long-term observational studies and a multicenter international registry are needed to better appreciate the impact of exposure, especially to newer mAbs.
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Affiliation(s)
- Anne Pham-Huy
- a Department of Pediatrics, Division of Infectious Diseases , Children's Hospital of Eastern Ontario, University of Ottawa , Ottawa , ON , Canada
| | - Manish Sadarangani
- b Vaccine Evaluation Center , BC Children's Hospital Research Institute, University of British Columbia , Vancouver , BC , Canada
| | - Vivian Huang
- c Division of Gastroenterology , Mount Sinai Hospital, University of Toronto , Toronto , ON , Canada
| | - Monika Ostensen
- d Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology , St. Olavs University Hospital , Trondheim , Norway.,e Department of Rheumatology , Sørlandet Sykehus , Kristiansand , Norway
| | - Eliana Castillo
- f Departments of Medicine and Obstetrics and Gyneacology , Cumming School of Medicine , Calgary , AB , Canada
| | - Sarah M Troster
- g Division of Rheumatology , University of Alberta , Edmonton , AB , Canada
| | - Wendy Vaudry
- h Division of infectious Diseases, Department of Pediatrics , University of Alberta, Stollery Children's Hospital , Edmonton , AB , Canada
| | - Geoffrey C Nguyen
- c Division of Gastroenterology , Mount Sinai Hospital, University of Toronto , Toronto , ON , Canada
| | - Karina A Top
- i Departments of Pediatrics and Community Health & Epidemiology , Dalhousie University , Halifax , NS , Canada
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Plachouri KM, Georgiou S. Special aspects of biologics treatment in psoriasis: management in pregnancy, lactation, surgery, renal impairment, hepatitis and tuberculosis. J DERMATOL TREAT 2018; 30:668-673. [PMID: 30428753 DOI: 10.1080/09546634.2018.1544413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background of the article: Biologics are modern immunomodulatory drugs, whose use in the treatment of psoriasis has led to remarkable results in psoriatic patients. The administration of these agents in special population groups, such as patients with chronic infections and renal impairment, as well as perioperative, pregnant or lactating patients, has not been thoroughly addressed, mostly because these patients are excluded from clinical studies. Materials and methods: This report is an updated systematic overview of the use of biologics in the above-mentioned types of patients and was conducted according to the PRISMA Guidelines for systematic reviews. Articles derived from the databases PubMed, EMBASE and SCOPUS, published between 1999 and 2018, were analyzed for the study. Results: Research efforts as well as clinical reporting are necessary in order to provide more insight on the management of these therapeutic dilemmas. Conclusion: The aim of this review, other than providing a summarized update on the clinical knowledge on this special topic, is also to raise awareness for the need to conduct larger systematic studies in order to adequately evaluate the use of biologics in these special patient categories and therefore draw definite conclusions on their safety profile.
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Affiliation(s)
- Kerasia-Maria Plachouri
- a Dermatology Department, University of Patras, University General Hospital of Patras , Patras , Greece
| | - Sophia Georgiou
- a Dermatology Department, University of Patras, University General Hospital of Patras , Patras , Greece
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12
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Matro R, Martin CF, Wolf D, Shah SA, Mahadevan U. Exposure Concentrations of Infants Breastfed by Women Receiving Biologic Therapies for Inflammatory Bowel Diseases and Effects of Breastfeeding on Infections and Development. Gastroenterology 2018; 155:696-704. [PMID: 29857090 DOI: 10.1053/j.gastro.2018.05.040] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/04/2018] [Accepted: 05/22/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND & AIMS Exposure to biologic and immunosuppressant agents during breastfeeding is controversial, and there are limited data on safety. We investigated whether biologics are detectable in breast milk from women receiving treatment for inflammatory bowel diseases (IBDs) and whether breastfeeding while receiving treatment is associated with infections or developmental delays. METHODS We performed a multicenter prospective study of women with IBD and their infants, collecting breast milk samples (n = 72) from patients receiving biologic therapy from October 2013 to November 2015. Drug concentrations were measured in all breast milk samples at several time points within 48 hours of collection and within 168 hours for some samples. Child development was assessed using the Ages and Stages Questionnaire 3, completed by 824 women with IBD (treated or untreated) during pregnancy (620 breastfed, and 204 did not). Data on children's health and development were obtained from mothers and pediatricians, along with information on mothers' medication exposure, IBD history, activity, pregnancy, and postpartum complications. We used chi-squared method or Fisher exact test to determine associations between categorical values and compared differences in continuous outcomes between groups using analysis of variance models. The primary outcome was drug concentration of biologic agents in breast milk (from 72 women) at 1, 12, 24, and 48 hours after dosing and also at 72, 96, 120, and 168 hours for available samples. Secondary outcomes were a range of infant infections and Ages and Stages Questionnaire 3-defined developmental delays among all breastfed infants. RESULTS We detected infliximab in breast milk samples from 19 of 29 treated women (maximum, 0.74 μg/mL), adalimumab in 2 of 21 treated women (maximum, 0.71 μg/mL), certolizumab in 3 of 13 treated women (maximum, 0.29 μg/mL), natalizumab in 1 of 2 treated women (maximum, 0.46 μg/mL), and ustekinumab in 4 of 6 treated women (maximum, 1.57 μg/mL); we did not detect golimumab in breast milk from the 1 woman receiving this drug. Rates of infection and developmental milestones at 12 months were similar in breastfed vs non-breastfed infants: any infection, 39% vs 39% in control individuals (P > .99) and milestone score, 87 vs 86 in control individuals (P = .9992). Rates of infection and developmental milestones did not differ among infants whose mothers received treatment with biologics, immunomodulators, or combination therapy compared with unexposed infants (whose mothers received treatment with mesalamines or steroids or no medication). CONCLUSIONS In a study of women receiving treatment for IBD and their infants, we detected low concentrations of infliximab, adalimumab, certolizumab, natalizumab, and ustekinumab in breast milk samples. We found breastfed infants of mothers on biologics, immunomodulators, or combination therapies to have similar risks of infection and rates of milestone achievement compared with non-breastfed infants or infants unexposed to these drugs. Maternal use of biologic therapy appears compatible with breastfeeding. Clinicaltrials.gov no.: NCT00904878.
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Affiliation(s)
- Rebecca Matro
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon.
| | - Christopher F Martin
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Douglas Wolf
- Atlanta Gastroenterology Associates, Atlanta, Georgia
| | - Samir A Shah
- Division of Gastroenterology, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Uma Mahadevan
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California
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Decision making and outcome of pregnancies in female patients with inflammatory bowel disease: findings from a community-based practice. Eur J Gastroenterol Hepatol 2018. [PMID: 29543610 DOI: 10.1097/meg.0000000000001117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate information provided on pregnancy, personal decision making, disease course, and outcome of pregnancy from a patient's perspective in a population of patients with inflammatory bowel disease (IBD) attending two general hospitals. PATIENTS AND METHODS A questionnaire was sent to all female patients with IBD in two general hospitals in the Netherlands. The questionnaire comprised four sections: (i) demographic data and medication use (ii) details on previous pregnancies and reasons for not becoming pregnant, (iii) outcome of pregnancies before IBD diagnosis, and (iv) outcome of pregnancies after IBD diagnosis. If necessary, medical records were reviewed to verify responses or for further medical details. RESULTS In total, 385 women returned the questionnaire, 501 completed pregnancies were reported, and 113 women had never been pregnant. In 272 women with at least one pregnancy, 334 pregnancies occurred before IBD diagnosis, 157 after IBD diagnosis, and in 10 cases, IBD was diagnosed during pregnancy. Medication for IBD was used in 67% of pregnancies after IBD diagnosis, mainly 5-ASA preparations (54%). Women with ulcerative colitis experienced more IBD-related complaints during pregnancy compared with women with Crohn's disease (25 vs. 14%, P=0.016). Additional medication (n=21) or surgery (n=2) for IBD during pregnancy was indicated in 14% of cases. Most women reported an uneventful pregnancy course (79%). Preterm birth occurred in 13% of pregnancies. CONCLUSION Pregnancy in women with IBD seen in a general hospital can be managed with a good outcome. Step-up therapy is needed in a minority of cases, and severe complications are rare.
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Clowse MEB, Feldman SR, Isaacs JD, Kimball AB, Strand V, Warren RB, Xibillé D, Chen Y, Frazier D, Geier J, Proulx J, Marren A. Pregnancy Outcomes in the Tofacitinib Safety Databases for Rheumatoid Arthritis and Psoriasis. Drug Saf 2017; 39:755-62. [PMID: 27282428 PMCID: PMC4933738 DOI: 10.1007/s40264-016-0431-z] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA), and is being investigated for the treatment of psoriasis. Both conditions can present in women of child-bearing potential, but pregnancy was an exclusion and discontinuation criterion in tofacitinib randomized controlled trials (RCTs) because of the unknown effects of tofacitinib on mother and child. Tofacitinib is a small molecule that has the potential to cross the placenta. OBJECTIVE The objective was to report outcomes of pregnancy cases identified through April 2014 from tofacitinib RA/psoriasis RCTs, RA post-approval non-interventional studies, and spontaneous adverse-event reporting. METHODS Pregnancy outcomes were categorized as follows: healthy newborn, medical termination, fetal death, congenital malformation, spontaneous abortion, or pending/lost to follow-up. RESULTS Out of 9815 patients, 1821 female patients of child-bearing age were enrolled in the RA/psoriasis RCTs; 47 women became pregnant, including 33 who received tofacitinib monotherapy, 13 who received combination therapy with methotrexate (RA patients only), and one patient whose therapy was still blinded. No fetal deaths were reported. One congenital pulmonary valve stenosis (monotherapy, n = 1), seven spontaneous abortions (monotherapy, n = 4; combination therapy, n = 3), and eight medical terminations (monotherapy, n = 4; combination therapy, n = 3; blinded therapy, n = 1) were identified. Remaining cases reported healthy newborns (n = 25) or were pending/lost to follow-up (n = 6). Forty-four cases of paternal exposure to tofacitinib were reported (monotherapy, n = 43; combination therapy, n = 1), including five spontaneous abortions (monotherapy, n = 4; combination therapy, n = 1), 23 healthy newborns, and 16 pending/lost to follow-up. CONCLUSIONS The pregnancy outcomes reported in this small number of RA/psoriasis patients appear similar to those observed in the general population and in patients treated with biologic therapies for inflammatory diseases. However, definitive conclusions cannot be drawn, and pregnancy outcomes in patients receiving tofacitinib will continue to be monitored.
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Affiliation(s)
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - John D Isaacs
- The NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alexandra B Kimball
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Richard B Warren
- Dermatology Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Daniel Xibillé
- Hospital General de Cuernavaca, Cuernavaca, Morelos, Mexico
| | - Yan Chen
- Pfizer Inc, 500 Arcola Rd, Collegeville, PA, 19426, USA
| | | | | | | | - Amy Marren
- Pfizer Inc, 500 Arcola Rd, Collegeville, PA, 19426, USA.
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Moaveni DM, Cohn JH, Hoctor KG, Longman RE, Ranasinghe JS. Anesthetic Considerations for the Parturient After Solid Organ Transplantation. Anesth Analg 2017; 123:402-10. [PMID: 27285002 DOI: 10.1213/ane.0000000000001391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Over the past 40 years, the success of organ transplantation has increased such that female solid organ transplant recipients are able to conceive and carry pregnancies successfully to term. Anesthesiologists are faced with the challenge of providing anesthesia care to these high-risk obstetric patients in the peripartum period. Anesthetic considerations include the effects of the physiologic changes of pregnancy on the transplanted organ, graft function in the peripartum period, and the maternal side effects and drug interactions of immunosuppressive agents. These women are at an increased risk of comorbidities and obstetric complications. Anesthetic management should consider the important task of protecting graft function. Optimal care of a woman with a transplanted solid organ involves management by a multidisciplinary team. In this focused review article, we review the anesthetic management of pregnant patients with solid organ transplants of the kidney, liver, heart, or lung.
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Affiliation(s)
- Daria M Moaveni
- From the Departments of *Clinical Anesthesiology and †Obstetrics and Gynecology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
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Shesternya PA, Petrova MM, Vasilyeva AO. [New horizons in the use of biological agents during pregnancy in patients with rheumatic disease]. TERAPEVT ARKH 2017. [PMID: 28631708 DOI: 10.17116/terarkh2017895105-112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pregnancy in the presence of rheumatic diseases (RD) and adequate therapy before planned conception, during gestation, and after delivery during lactation is challenging. Advances in the treatment of RD are largely due to the clinical introduction of a new class of biological agents (BAs). There are less than two decades of experience in using BAs in rheumatology and to date there are no unified standards and accepted rules governing their use during pregnancy. According to the current requirements, information on a medicine should be given in three sections: 1) pregnancy; 2) lactation, and 3) use in men and women who are planning concept (the latter section has appeared for the first time). The present article summarizes data on the possible use of BAs in patients with RD during pregnancy planning, pregnancy, and breastfeeding.
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Affiliation(s)
- P A Shesternya
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, Krasnoyarsk, Russia
| | - M M Petrova
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, Krasnoyarsk, Russia
| | - A O Vasilyeva
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, Krasnoyarsk, Russia
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Wang J, Johnson T, Sahin L, Tassinari MS, Anderson PO, Baker TE, Bucci-Rechtweg C, Burckart GJ, Chambers CD, Hale TW, Johnson-Lyles D, Nelson RM, Nguyen C, Pica-Branco D, Ren Z, Sachs H, Sauberan J, Zajicek A, Ito S, Yao LP. Evaluation of the Safety of Drugs and Biological Products Used During Lactation: Workshop Summary. Clin Pharmacol Ther 2017; 101:736-744. [PMID: 28510297 DOI: 10.1002/cpt.676] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 12/15/2022]
Abstract
This report serves as a summary of a 2-day public workshop sponsored by the US Food and Drug Administration (FDA) to discuss the safety of drugs and biological products used during lactation. The aim of the workshop was to provide a forum to discuss the collection of data to inform the potential risks to breastfed infants with maternal use of medications during lactation. Discussions included the review of current approaches to collect data on medications used during lactation, and the considerations for future approaches to design and guide clinical lactation studies. This workshop is part of continuing efforts to raise the awareness of the public for women who choose to breastfeed their infants.
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Affiliation(s)
- J Wang
- Office of Drug Evaluation IV, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - T Johnson
- Division of Pediatric and Maternal Health, Office of Drug Evaluation IV, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - L Sahin
- Division of Pediatric and Maternal Health, Office of Drug Evaluation IV, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - M S Tassinari
- Division of Pediatric and Maternal Health, Office of Drug Evaluation IV, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - P O Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
| | - T E Baker
- Infantrisk Center, Texas Tech University Health Sciences Center Amarillo, Amarillo, Texas, USA
| | - C Bucci-Rechtweg
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, New Jersey, USA
| | - G J Burckart
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - C D Chambers
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - T W Hale
- Infantrisk Center, Texas Tech University Health Sciences Center Amarillo, Amarillo, Texas, USA
| | - D Johnson-Lyles
- Division of Pediatric and Maternal Health, Office of Drug Evaluation IV, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - R M Nelson
- Office of Pediatric Therapeutics, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - C Nguyen
- Division of Bone, Reproductive, and Urologic Products, Office of Drug Evaluation III, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - D Pica-Branco
- Division of Pediatric and Maternal Health, Office of Drug Evaluation IV, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Z Ren
- Obstetric and Pediatric Pharmacology and Therapeutics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, Bethesda, Maryland, USA
| | - H Sachs
- Division of Pediatric and Maternal Health, Office of Drug Evaluation IV, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - J Sauberan
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
| | - A Zajicek
- Obstetric and Pediatric Pharmacology and Therapeutics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, Bethesda, Maryland, USA
| | - S Ito
- Division of Clinical Pharmacology & Toxicology, Department of Pediatrics, Hospital For Sick Children, Toronto, Ontario, Canada
| | - L P Yao
- Division of Pediatric and Maternal Health, Office of Drug Evaluation IV, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Enfermedad de Crohn: hemorragia fatal en paciente con 19.3 semanas de gestación. Reporte de un caso y revisión de la literatura mundial. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2017. [DOI: 10.1016/j.gine.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jamieson C, Morosan M, Cameron M. Crohn's disease: First diagnosis in pregnancy and management. Obstet Med 2016; 10:85-87. [PMID: 28680469 DOI: 10.1177/1753495x16671231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 08/29/2016] [Indexed: 12/11/2022] Open
Abstract
This case addresses the difficulty in the initial diagnosis of severe Crohn's disease in pregnancy as well as the challenges of instituting remission therapy towards the end of second trimester. The patient's course was complicated by recurrent hospital admissions and intolerance to diet requiring temporary nasogastric feeding. Medical management included the use of biological agents during pregnancy, which allowed for better symptomatic control. She sustained no further complications and underwent a successful vaginal delivery of a healthy baby at 37 weeks' gestation.
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Affiliation(s)
- C Jamieson
- Department of Gastroenterology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - M Morosan
- Department of Anaesthesia, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - M Cameron
- Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
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Lee J, Moraes-Vieira PM, Castoldi A, Aryal P, Yee EU, Vickers C, Parnas O, Donaldson CJ, Saghatelian A, Kahn BB. Branched Fatty Acid Esters of Hydroxy Fatty Acids (FAHFAs) Protect against Colitis by Regulating Gut Innate and Adaptive Immune Responses. J Biol Chem 2016; 291:22207-22217. [PMID: 27573241 DOI: 10.1074/jbc.m115.703835] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Indexed: 12/25/2022] Open
Abstract
We recently discovered a structurally novel class of endogenous lipids, branched palmitic acid esters of hydroxy stearic acids (PAHSAs), with beneficial metabolic and anti-inflammatory effects. We tested whether PAHSAs protect against colitis, which is a chronic inflammatory disease driven predominantly by defects in the innate mucosal barrier and adaptive immune system. There is an unmet clinical need for safe and well tolerated oral therapeutics with direct anti-inflammatory effects. Wild-type mice were pretreated orally with vehicle or 5-PAHSA (10 mg/kg) and 9-PAHSA (5 mg/kg) once daily for 3 days, followed by 10 days of either 0% or 2% dextran sulfate sodium water with continued vehicle or PAHSA treatment. The colon was collected for histopathology, gene expression, and flow cytometry. Intestinal crypt fractions were prepared for ex vivo bactericidal assays. Bone marrow-derived dendritic cells pretreated with vehicle or PAHSA and splenic CD4+ T cells from syngeneic mice were co-cultured to assess antigen presentation and T cell activation in response to LPS. PAHSA treatment prevented weight loss, improved colitis scores (stool consistency, hematochezia, and mouse appearance), and augmented intestinal crypt Paneth cell bactericidal potency via a mechanism that may involve GPR120. In vitro, PAHSAs attenuated dendritic cell activation and subsequent T cell proliferation and Th1 polarization. The anti-inflammatory effects of PAHSAs in vivo resulted in reduced colonic T cell activation and pro-inflammatory cytokine and chemokine expression. These anti-inflammatory effects appear to be partially GPR120-dependent. We conclude that PAHSA treatment regulates innate and adaptive immune responses to prevent mucosal damage and protect against colitis. Thus, PAHSAs may be a novel treatment for colitis and related inflammation-driven diseases.
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Affiliation(s)
- Jennifer Lee
- From the Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, and
| | - Pedro M Moraes-Vieira
- From the Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, and
| | - Angela Castoldi
- From the Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, and
| | - Pratik Aryal
- From the Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, and
| | - Eric U Yee
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215
| | - Christopher Vickers
- the Clayton Foundation Laboratories for Peptide Biology, Helmsley Center for Genomic Medicine, Salk Institute for Biological Studies, La Jolla, California 92037, and
| | - Oren Parnas
- the Broad Institute of the Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts 02142
| | - Cynthia J Donaldson
- the Clayton Foundation Laboratories for Peptide Biology, Helmsley Center for Genomic Medicine, Salk Institute for Biological Studies, La Jolla, California 92037, and
| | - Alan Saghatelian
- the Clayton Foundation Laboratories for Peptide Biology, Helmsley Center for Genomic Medicine, Salk Institute for Biological Studies, La Jolla, California 92037, and
| | - Barbara B Kahn
- From the Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, and
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Spencer B. Medications and Breastfeeding for Mothers With Chronic Illness. J Obstet Gynecol Neonatal Nurs 2015; 44:543-552. [DOI: 10.1111/1552-6909.12663] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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