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Alhamam A, Garabed LR, Julian S, Flannigan R. The association of medications and supplements with human male reproductive health: a systematic review. Fertil Steril 2023; 120:1112-1137. [PMID: 37898470 DOI: 10.1016/j.fertnstert.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
Some medications used to treat comorbidities and conditions in reproductive-aged individuals could have a negative impact on fertility. This may occur through hormonal disruption, toxicity to germ cells and spermatozoa, functional impact on the sperm, teratogenicity potential, or ejaculatory abnormalities. Having knowledge of these potential interactions between medications and reproductive potential is important for clinicians to be aware of and guide the patient, along with their treating clinicians, to reproductively favorable alternatives when available. This review aims to summarize the state of the literature regarding medication interactions with human male reproduction using the Anatomical Therapeutic Chemical Classification System of medications.
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Affiliation(s)
- Abdullah Alhamam
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Laurianne Rita Garabed
- Division of Urology, Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Sania Julian
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan Flannigan
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urology, Weill Cornell Medicine, New York, New York.
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2
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Russell MD, Dey M, Flint J, Davie P, Allen A, Crossley A, Frishman M, Gayed M, Hodson K, Khamashta M, Moore L, Panchal S, Piper M, Reid C, Saxby K, Schreiber K, Senvar N, Tosounidou S, van de Venne M, Warburton L, Williams D, Yee CS, Gordon C, Giles I, Roddy E, Armon K, Astell L, Cotton C, Davidson A, Fordham S, Jones C, Joyce C, Kuttikat A, McLaren Z, Merrison K, Mewar D, Mootoo A, Williams E. British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford) 2022; 62:e48-e88. [PMID: 36318966 PMCID: PMC10070073 DOI: 10.1093/rheumatology/keac551] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Mark D Russell
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Mrinalini Dey
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Julia Flint
- Department of Rheumatology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Shropshire, UK
| | - Philippa Davie
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Alexander Allen
- Clinical Affairs, British Society for Rheumatology, London, UK
| | | | - Margreta Frishman
- Rheumatology, North Middlesex University Hospital NHS Trust, London, UK
| | - Mary Gayed
- Rheumatology, Sandwell and West Birmingham Hospitals, Birmingham, UK
| | | | - Munther Khamashta
- Lupus Research Unit, Division of Women's Health, King's College London, London, UK
| | - Louise Moore
- Rheumatic and Musculoskeletal Disease Unit, Our Lady's Hospice and Care Service, Dublin, Ireland
| | - Sonia Panchal
- Department of Rheumatology, South Warwickshire NHS Foundation Trust, Warwickshire, UK
| | - Madeleine Piper
- Royal National Hospital for Rheumatic Diseases, Royal United Hospital, Bath, UK
| | | | - Katherine Saxby
- Pharmacy, University College London Hospitals NHS Foundation Trust, London, UK
| | - Karen Schreiber
- Thrombosis and Haemostasis, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Rheumatology, Danish Hospital for Rheumatic Diseases, Sonderborg, Denmark.,Department of Regional Health Research (IRS), University of Southern Denmark, Odense, Denmark
| | - Naz Senvar
- Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sofia Tosounidou
- Lupus UK Centre of Excellence, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | | | - David Williams
- Obstetrics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chee-Seng Yee
- Department of Rheumatology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ian Giles
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
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3
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Mahadevan U, Naureckas S, Tikhonov I, Wang Y, Lin CB, Geldhof A, van der Woude CJ. Pregnancy outcomes following periconceptional or gestational exposure to ustekinumab: Review of cases reported to the manufacturer's global safety database. Aliment Pharmacol Ther 2022; 56:477-490. [PMID: 35560249 DOI: 10.1111/apt.16960] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/17/2022] [Accepted: 04/22/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Ustekinumab, a human immunoglobulin G1 monoclonal antibody that binds to and inhibits interleukin (IL)-12/IL-23, is indicated for multiple immune-mediated diseases. Ustekinumab is actively transported across the placenta and theoretically could impact pregnancy outcomes. Limited data on pregnancy outcomes with ustekinumab exposure are available. AIM To assess pregnancy outcomes in patients exposed to ustekinumab during pregnancy METHODS: Cumulative data on medically confirmed ustekinumab-exposed pregnancies from the manufacturer's Global Safety Database were summarised. Descriptive data for pregnancy outcomes were presented overall and by patient subgroups. RESULTS As of 31 August 2020, 408 medically confirmed, prospective, maternal ustekinumab-exposed pregnancies with reported outcomes were identified. The mean maternal age was 31 years. Of the 420 pregnancy outcomes (including 4 sets of twins),a , b 340 (81%) were live births, 51 (12.1%) spontaneous abortions, 25 (6%) elective/induced abortions, 3 (0.7%) stillbirths and 1 (0.2%) ongoing pregnancy with foetal congenital anomaly (CA). Among 340 live births, 33 (9.7%) were born pre-term. The rate of major CAs was similar by indication (Crohn's disease vs psoriasis), ustekinumab dose (45 mg vs 90 mg) and timing and duration of maternal exposure to ustekinumab. Prospective outcomes of pregnancies with paternal periconceptional ustekinumab exposure (n = 87) included 92% live births (1.2% major CA), 5.7% spontaneous abortions and 2.3% elective/induced abortions. CONCLUSIONS Rates of adverse pregnancy outcomes or CAs with ustekinumab exposure were consistent with rates reported for the US general population and do not suggest a higher risk associated with maternal or paternal exposure to ustekinumab.
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Affiliation(s)
- Uma Mahadevan
- University of California San Francisco, San Francisco, California, USA
| | - Saule Naureckas
- Janssen Research and Development, LLC, Raritan, New Jersey, USA
| | - Ilia Tikhonov
- Janssen Research and Development, LLC, Raritan, New Jersey, USA
| | - Yiting Wang
- Janssen Research and Development, LLC, Spring House, Pennsylvania, USA
| | - Connie B Lin
- Janssen Research and Development, LLC, Horsham, Pennsylvania, USA
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4
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El Miedany Y, Palmer D. Rheumatology-led pregnancy clinic: men perspective. Clin Rheumatol 2021; 40:3067-3077. [PMID: 33449229 PMCID: PMC8289755 DOI: 10.1007/s10067-020-05551-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 10/26/2022]
Abstract
The birth of reproductive rheumatology as a subject of interest in rheumatology has led to improvement of clinical care for patients living with autoimmune rheumatic diseases and paved the way towards setting a specialized pregnancy service within the standard rheumatology practice. In contrast to women, where there has been wealth of literature regarding pregnancy, lactation, and birth outcomes, there is not as much focusing on male sexual health and outcomes among inflammatory arthritis patients. Challenges such as decrease ability to conceive, impaired fertility, erectile dysfunction, and other sexual problems have been raised by male patients living with autoimmune rheumatic diseases. This broad scope gives the reproductive health concept in men another expansion with views to include sexual health problems screening among men attending the standard outpatient rheumatology clinics. This article adds to the paucity of real-life experience and aims at discussing the sexual health from the men perspective and provides a practical approach towards screening, and assessment of men living with autoimmune diseases in standard day to day practice.
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Affiliation(s)
| | - Deborah Palmer
- Rheumatology Department, North Middlesex University Hospital, London, England
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5
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Perez-Garcia LF, Dolhain RJEM, Vorstenbosch S, Bramer W, van Puijenbroek E, Hazes JMW, Te Winkel B. The effect of paternal exposure to immunosuppressive drugs on sexual function, reproductive hormones, fertility, pregnancy and offspring outcomes: a systematic review. Hum Reprod Update 2021; 26:961-1001. [PMID: 32743663 PMCID: PMC7600290 DOI: 10.1093/humupd/dmaa022] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/17/2020] [Accepted: 05/01/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Information regarding the possible influence of immunosuppressive drugs on male sexual function and reproductive outcomes is scarce. Men diagnosed with immune-mediated diseases and a wish to become a father represent an important neglected population since they lack vital information to make balanced decisions about their treatment. OBJECTIVE AND RATIONALE The aim of this research was to systematically review the literature for the influence of paternal immunosuppressive drug use on many aspects of male sexual health, such as sexual function, fertility, pregnancy outcomes and offspring health outcomes. SEARCH METHODS A systematic literature search was performed in the bibliographic databases: Embase (via Elsevier embase.com), MEDLINE ALL via Ovid, Cochrane Central Register of Trials (via Wiley) and Web of Science Core Collection. Additionally, Google Scholar and the Clinical trial registries of Europe and the USA were searched. The databases were searched from inception until 31 August 2019. The searches combined keywords regarding male sexual function and fertility, pregnancy outcomes and offspring health with a list of immunosuppressive drugs. Studies were included if they were published in English and if they included original data on male human exposure to immunosuppressive drugs. A meta-analysis was not possible to perform due to the heterogeneity of the data. OUTCOMES A total of 5867 references were identified, amongst which we identified 161 articles fulfilling the eligibility criteria. Amongst these articles, 50 included pregnancy and offspring outcomes and 130 included sexual health outcomes. Except for large Scandinavian cohorts, most of the identified articles included a small number of participants. While a clear negative effect on sperm quality was evident for sulfasalazine and cyclophosphamide, a dubious effect was identified for colchicine, methotrexate and sirolimus. In three articles, exposure to tumour necrosis factor-α inhibitors in patients diagnosed with ankylosing spondylitis resulted in improved sperm quality. The information regarding pregnancy and offspring outcomes was scant but no large negative effect associated with paternal immunosuppressive drug exposure was reported. WIDER IMPLICATIONS Evidence regarding the safety of immunosuppressive drugs in men with a wish to become a father is inconclusive. The lack of standardisation on how to evaluate and report male sexual function, fertility and reproduction as study outcomes in men exposed to immunosuppressive drugs is an important contributor to this result. Future research on this topic is needed and should be preferably done using standardised methods.
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Affiliation(s)
- L F Perez-Garcia
- Department of Rheumatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - R J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - S Vorstenbosch
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH 's-Hertogenbosch, The Netherlands
| | - W Bramer
- Medical Library, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - E van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH 's-Hertogenbosch, The Netherlands.,Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology and Economics, University of Groningen, 9712 CP Groningen, The Netherlands
| | - J M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - B Te Winkel
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH 's-Hertogenbosch, The Netherlands
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6
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Finelli R, Leisegang K, Finocchi F, De Masi S, Agarwal A, Damiani G. The impact of autoimmune systemic inflammation and associated medications on male reproductive health in patients with chronic rheumatological, dermatological, and gastroenterological diseases: A systematic review. Am J Reprod Immunol 2021; 85:e13389. [PMID: 33420722 DOI: 10.1111/aji.13389] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/04/2021] [Indexed: 01/13/2023] Open
Abstract
Autoimmune disorders currently affect 5%-8% of the global population, characterized by an aberrant chronic inflammatory response to self-antigens. The aim of this study was to systematically review the current available evidence investigating the impact of systemic autoimmune diseases and associated immunosuppressive treatment on fertility parameters of adult men. Clinical trials, observational studies, and case reports written in English and reporting semen analysis, evaluation of seminal oxidative stress, and/or sperm DNA fragmentation in patients affected by psoriasis and psoriatic arthritis, celiac disease, inflammatory bowel diseases, systemic lupus erythematosus, ankylosing spondylitis, hidradenitis suppurativa, uveitis, dermatomyositis, and rheumatoid arthritis were collected by searching on PubMed, EMBASE, OVID, Scopus, and Cochrane Library databases, with no limit of time. The study quality and the extent of bias in design, methods, and outcome assessment were evaluated by applying the Joanna Briggs Institute Critical Appraisal tools. Evidence suggested that various autoimmune diseases or relevant medications can adversely affect male fertility parameters and that patients may benefit of counseling and sperm cryopreservation. Clinical trials further investigating any adverse effect of autoimmunity and related thereby on male infertility are warranted, to develop appropriate guidelines for males diagnosed and treated for autoimmune disorders.
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Affiliation(s)
- Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kristian Leisegang
- School of Natural Medicine, University of the Western Cape, Cape Town, South Africa
| | - Federica Finocchi
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | | | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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7
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Banerjee A, Scarpa M, Pathak S, Burra P, Sturniolo GC, Russo FP, Murugesan R, D'Incá R. Inflammatory Bowel Disease Therapies Adversely Affect Fertility in Men- A Systematic Review and Meta-analysis. Endocr Metab Immune Disord Drug Targets 2020; 19:959-974. [PMID: 30864530 DOI: 10.2174/1871530319666190313112110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Sexual functions are sometimes adversely affected by the therapeutic drugs delivered for treating IBD. Much attention has been focused on pregnancy/sexual issues in women. Relatively less attention has been poured in to address this issue in men. This systematic review assesses the drugs having potential detrimental effects on fertility in men. METHODS Three databases were searched by two researchers independently for potentially relevant publications between 1964 to 2015 and 249 papers were retrieved. Studies that dealt with sexual problems after IBD drugs administration were included in the purview of this review. RESULTS Fourteen studies with 327 human patients and 110 animals were analysed. Sulphasalazine treated patients had lower spermatozoa count, lower sperm motility and higher risk of oligospermia compared to mesalazine treated ones. Biologics seem to be safe to use while attempting to conceive however, proper clinical studies reporting male fertility problems in IBD patients are lacking. Azathioprine caused oligospermia but a meta-analytical approach was not possible due to heterogeneity in studies. Some animal studies showed methotrexate affects abnormal testis structure and spermatogenesis. CONCLUSION This study summarises the current literature and safety issues affecting fertility parameters in men and animals treated with IBD therapeutic drugs, which can further assist clinicians in better management of adult male IBD patients.
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Affiliation(s)
- Antara Banerjee
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology/Multivisceral Transplant Unit, University Hospital Padova, Padova, Italy.,Faculty of Allied Health Science (FAHS), Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai, India
| | - Marco Scarpa
- Oncological Surgery Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | - Surajit Pathak
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology/Multivisceral Transplant Unit, University Hospital Padova, Padova, Italy.,Faculty of Allied Health Science (FAHS), Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai, India
| | - Patrizia Burra
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology/Multivisceral Transplant Unit, University Hospital Padova, Padova, Italy
| | - Giacomo C Sturniolo
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology/Multivisceral Transplant Unit, University Hospital Padova, Padova, Italy
| | - Francesco P Russo
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology/Multivisceral Transplant Unit, University Hospital Padova, Padova, Italy
| | - Ram Murugesan
- Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai, India
| | - Renata D'Incá
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology/Multivisceral Transplant Unit, University Hospital Padova, Padova, Italy
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8
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A Pharmacological Approach to Managing Inflammatory Bowel Disease During Conception, Pregnancy and Breastfeeding: Biologic and Oral Small Molecule Therapy. Drugs 2019; 79:1053-1063. [PMID: 31183768 DOI: 10.1007/s40265-019-01141-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The inflammatory bowel diseases commonly affect individuals during their peak reproductive years. Patients are often concerned about the impact of medical therapies on their ability to conceive, effect on the fetus, as well as the ability to breastfeed, which has led to poor medical adherence during pregnancy. However, most medications are safe, and discontinuation may lead to active disease, which is associated with adverse materno-fetal outcomes. The anti-TNF biologic therapies, infliximab and adalimumab have been extensively studied in the context of pregnancy. They are actively transferred to the placenta during the second and third trimesters; these have not been associated with an increased rate of congenital abnormalities or fetal death. The minimal amounts of drug that are transferred to breast milk are proteolyzed by the infant's digestive system with no reported short- or long-term adverse effects. There is a paucity of clinical data for the other approved anti-TNF agents or newer anti-integrin (vedolizumab) and anti-interleukin (ustekinumab) therapies used in the management of inflammatory bowel disease; however, no significant safety signals have been documented thus far. The new oral small molecule therapy, tofacitinib is teratogenic in animal models and is contra-indicated in patients attempting pregnancy. It is important that patients, as well as physicians managing patients with these conditions, be aware of the impact of these medical therapies during pregnancy.
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9
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Shannahan SE, Erlich JM, Peppercorn MA. Insights into the treatment of inflammatory bowel disease in pregnancy. Therap Adv Gastroenterol 2019; 12:1756284819852231. [PMID: 31191713 PMCID: PMC6540496 DOI: 10.1177/1756284819852231] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/17/2019] [Indexed: 02/04/2023] Open
Abstract
Patients diagnosed with inflammatory bowel disease (IBD) are most commonly diagnosed in late adolescence or early adulthood, with half of patients being diagnosed before age 32, thus impacting peak years of reproduction and family planning. While controlled IBD has no negative effects on the ability to conceive, there is overall a trend towards voluntary childlessness due to patients' concerns for adverse fetal outcomes from underlying IBD and from adverse medication effects. Active disease at the time of conception is associated with worsening disease activity during pregnancy and carries a higher risk of poor fetal outcomes. It is therefore important to maintain remission during pregnancy, which is often achieved with pharmacologic therapy. The goal of this paper is to provide a comprehensive review of the current literature and safety data for pharmacologic treatment of IBD in pregnancy, in breastfeeding women, and in men planning to have children.
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Affiliation(s)
- Sarah E. Shannahan
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jonathan M. Erlich
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mark A. Peppercorn
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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10
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New changes in pregnancy and lactation labelling: Review of dermatologic drugs. Int J Womens Dermatol 2019; 5:216-226. [PMID: 31700976 PMCID: PMC6831768 DOI: 10.1016/j.ijwd.2019.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/15/2019] [Accepted: 05/02/2019] [Indexed: 12/24/2022] Open
Abstract
Background The U.S. Food and Drug Administration has published new pregnancy and lactation labelling rules that set standards on the presentation of information with regard to drug usage during pregnancy and breastfeeding, as well as the effects on fertility. These guidelines became effective June 30, 2015, and classified the risks of using prescription drugs during pregnancy in three detailed subsections: Pregnancy, Lactation, and Females and Males of Reproductive Potential. These sections describe the risks within a real-world context of caring for these patients. Objective In this study, we reclassified and categorized drugs and treatments commonly used in dermatology according to these new guidelines. Methods We performed a search of the medical literature about the use of relevant prescription drugs during pregnancy and breastfeeding and their effect on fertility. The search included prospective and retrospective studies, review articles from PubMed-indexed journals (from inception to November 2018), U.S. Food and Drug Administration records, pregnancy exposure registries, relevant information and studies provided in drug labeling by companies, and updated pharmacologic texts and guidelines up to 2018. Results Topical immunomodulators, systemic immunomodulators (including biologics), systemic antipruritic agents, antimicrobials, as well as acne, hair, and cosmetic agents were included. We have made best attempts to review and consolidate existing and new data and include them in our guide. Conclusion This new narrative format facilitates prescribing by considering a variety of factors. One previously overlooked aspect was the impact on the reproductive potential of both male and female patients. Rather than depending on overly simplistic letter risk categories, dermatologists will now need to make prescribing decisions based on each patient and the information provided, which will allow for better decision making and patient care.
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11
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Safety of anti-rheumatic drugs in men trying to conceive: A systematic review and analysis of published evidence. Semin Arthritis Rheum 2019; 48:911-920. [DOI: 10.1016/j.semarthrit.2018.07.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/18/2018] [Accepted: 07/23/2018] [Indexed: 12/31/2022]
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12
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Micu MC, Ostensen M, Bojincă V, Șerban O, Mihai M, Suța C, Ramazan A, Enache L, Bobircă A, Pătcaș SF, Micu R, Ionescu R. Pregnancy Outcomes in Couples with Males Exposed to Longterm Anti-tumor Necrosis Factor- α Inhibitor Therapies: A Prospective Study. J Rheumatol 2019; 46:1084-1088. [PMID: 30824658 DOI: 10.3899/jrheum.180588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the pregnancy achievement and outcomes in couples in which men with spondyloarthritis (SpA) were exposed to tumor necrosis factor inhibitors (TNFi). METHODS Information about pregnancies involving fathers with SpA was prospectively collected by 6 Romanian rheumatology centers. RESULTS Twenty-seven patients achieved 33 pregnancies and fathered 30 healthy children. Three elective abortions (personal reasons) and no spontaneous abortions, preeclampsia/eclampsia, stillbirths, congenital malformations, or pathologies in the children were recorded. Five patients showed normospermia before and after longterm TNFi treatment. CONCLUSION Pregnancy and child outcomes in male patients with SpA exposed to longterm TNFi therapy were reassuring.
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Affiliation(s)
- Mihaela C Micu
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Monika Ostensen
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Violeta Bojincă
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Oana Șerban
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Minodora Mihai
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Cristina Suța
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Anamaria Ramazan
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Luminița Enache
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Anca Bobircă
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Sergiu F Pătcaș
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Romeo Micu
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway. .,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report.
| | - Ruxandra Ionescu
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
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Paternal exposure to antirheumatic drugs—What physicians should know: Review of the literature. Semin Arthritis Rheum 2018; 48:343-355. [DOI: 10.1016/j.semarthrit.2018.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/19/2017] [Accepted: 01/09/2018] [Indexed: 12/11/2022]
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14
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Brown SM, Aljefri K, Waas R, Hampton P. Systemic medications used in treatment of common dermatological conditions: safety profile with respect to pregnancy, breast feeding and content in seminal fluid. J DERMATOL TREAT 2018; 30:2-18. [PMID: 28092212 DOI: 10.1080/09546634.2016.1202402] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Prescribing for pregnant or lactating patients and male patients wishing to father children can be a difficult area for dermatologists. There is a lack of review articles of commonly used systemic medications in dermatology with respect to their effects on developing embryogenesis and their potential transfer across the placenta, in breast milk and in seminal fluid. This paper aims to provide an up to date summary of evidence to better equip dermatologists to inform patients about the effects of systemic medications commonly used in dermatology to treat conditions such as atopic dermatitis, psoriasis and acne, on current and future embryogenesis and fertility.
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Affiliation(s)
| | - Khadija Aljefri
- a Dermatology Department , Royal Victoria Infirmary , Newcastle Upon Tyne , UK
| | - Rachel Waas
- a Dermatology Department , Royal Victoria Infirmary , Newcastle Upon Tyne , UK
| | - Philip Hampton
- a Dermatology Department , Royal Victoria Infirmary , Newcastle Upon Tyne , UK
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15
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Pascarelli NA, Fioravanti A, Moretti E, Guidelli GM, Mazzi L, Collodel G. The effects in vitro of TNF-α and its antagonist 'etanercept' on ejaculated human sperm. Reprod Fertil Dev 2018; 29:1169-1177. [PMID: 27185240 DOI: 10.1071/rd16090] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 03/16/2016] [Indexed: 12/22/2022] Open
Abstract
Tumour necrosis factor (TNF)-α is primarily involved in the regulation of cell proliferation and apoptosis; in addition it possesses pro-inflammatory properties. Anti-TNF-α strategies involve either administration of anti-TNF-α antibody or soluble TNF receptor to mop up circulating TNF-α. Etanercept, a recombinant human TNF-α receptor, was found to be effective in the treatment of rheumatoid arthritis. The impact of TNF-α inhibitors on human fertility is of notable interest. This in vitro study investigated the effect of different concentrations of TNF-α and etanercept used alone or in combination on sperm viability, motility, mitochondrial function, percentage of apoptosis and chromatin integrity in swim-up selected human spermatozoa. A negative effect of TNF-α (300 and 500ng mL-1) and etanercept (from 800µg mL-1 to 2000µg mL-1) individually on sperm viability, motility, mitochondrial function, percentage of apoptotic spermatozoa and sperm DNA integrity was demonstrated. However, at concentrations of 100 and 200µg mL-1, etanercept can block, in a significant way, the toxic effects of TNF-α (500ng mL-1) on studied sperm characteristics. Our results confirm that TNF-α has a detrimental effect on sperm function and suggest, for the first time, that etanercept may counteract the in vitro toxic action of TNF-α. This data appears to be quite promising, although further studies, both in vivo and in vitro, are needed to understand the exact mechanism of action of TNF-α and TNF-α antagonists on sperm function.
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Affiliation(s)
- Nicola A Pascarelli
- Rheumatology Unit, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci, 14, 53100, Siena, Italy
| | - Antonella Fioravanti
- Rheumatology Unit, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci, 14, 53100, Siena, Italy
| | - Elena Moretti
- Department of Molecular and Developmental Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci, 14, 53100, Siena, Italy
| | - Giacomo M Guidelli
- Rheumatology Unit, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci, 14, 53100, Siena, Italy
| | - Lucia Mazzi
- Department of Molecular and Developmental Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci, 14, 53100, Siena, Italy
| | - Giulia Collodel
- Department of Molecular and Developmental Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci, 14, 53100, Siena, Italy
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16
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Abstract
There has been considerable literature on sexual issues in women with inflammatory bowel disease (IBD), but relatively little attention has been paid to these aspects in men. To review the available literature and to provide the best management of sexual and reproductive issues in male patients with IBD. The scientific literature on sexual and reproductive issues in men with IBD was reviewed. Several factors, including surgical and medication treatments, disease activity, lifestyle, and psychological factors, may play a role in the development of infertility and sexual dysfunction and may negatively impact pregnancy outcomes. Proctocolectomy with ileal pouch-anal anastomosis increases the risk of erectile and ejaculatory dysfunction by up to 26%. A treatment with sildenafil can be effective. Sperm banking should be advised to young men with IBD before surgery. Both sulfasalazine and methotrexate may be responsible for reversible sexual dysfunction and infertility. Furthermore, sulfasalazine should be switched to mesalazine at least 4 months before conception because of a higher risk of congenital malformations in pregnancies fathered by men treated with this drug. Psychotropic drugs, frequently used in IBD, may cause sexual dysfunction up to 80%. Last but not the least, voluntary childlessness occurs frequently, mainly because of concerns about medication safety in pregnancy and fear of transmitting disease. Accurate counseling, and where necessary, psychological support can decrease any misperceptions and fears. Close collaboration between the gastroenterologist and the patient is recommended for the best management of these relevant, neglected aspects in men with IBD.
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17
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Cohn HM, Dave M, Loftus EV. Understanding the Cautions and Contraindications of Immunomodulator and Biologic Therapies for Use in Inflammatory Bowel Disease. Inflamm Bowel Dis 2017; 23:1301-1315. [PMID: 28708806 PMCID: PMC5731468 DOI: 10.1097/mib.0000000000001199] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Ulcerative colitis and Crohn's disease are chronic inflammatory bowel diseases for which there are no cures. These diseases are immunopathogenic, and medical treatment is centered on the temperance of a dysregulated immune response to allow mucosal healing and prevent the sequelae of fistulation and stenosis. Accordingly, the armamentarium of medications, which has expanded immensely in recent history, is not without significant infectious and neoplastic risks. Many of these untoward effects can be mitigated by screening and avoidance of contraindicated medications. This review seeks to highlight the cautions for use of immunomodulators, anticytokine, and α4-integrin antagonists. The potential adverse events are further complicated by substantial heterogeneity in disease phenotype in the inflammatory bowel disease population. Large patient registries and databases provide considerable experience and knowledge to calculate the incidence of safety outcomes. To identify rarer outcomes after prolonged therapy, more prospective studies and continued adverse event reporting will aid safe application and minimize potential harms.
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Affiliation(s)
- H. Matthew Cohn
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Maneesh Dave
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
- Division of Gastroenterology and Liver Disease, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Edward V. Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota Review Article for Inflammatory Bowel Disease Journal
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18
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Abstract
BACKGROUND Data on fertility rates and medication safety in men with inflammatory bowel disease (IBD) are limited. The aim of this study was to evaluate whether there is a seminal alteration in patients with IBD and, if so, to evaluate the mechanisms that may play a role according to what has been described in the literature. Its secondary aim was to evaluate the impact on male sexual function of IBD. METHODS Multicenter, cross-sectional, case series study comparing men with IBD and control subjects. Semen analysis was performed according to the recommendations of World Health Organization. The impact on male sexual function was evaluated with the International Index of Erectile Function questionnaire. RESULTS On multivariate analysis, patients with Crohn's disease had lower sperm concentrations compared with those with ulcerative colitis (median [interquartile range], 34.5 [19.2-48] versus 70 [34.5-127.5], P = 0.02) and lower seminal zinc levels (mean ± SD, 1475 ± 235 μmol/L versus 2221 ± 1123 μmol/L, P = 0.04). Patients with Crohn's disease on anti-tumor necrosis factor treatment had better progressive motility (mean ± SD, 56.7 ± 17.7 versus 35.1 ± 22.1, P = 0.01) and sperm morphology (14.4 ± 7.1 versus 7.6 ± 4.9, P = 0.04) than those who were not on anti-tumor necrosis factor. Regarding sexual function, no significant differences were found across patients with IBD and control subjects. CONCLUSIONS Men with Crohn's disease showed a trend toward poorer semen quality than those with ulcerative colitis. Treatment with anti-tumor necrosis factor drugs does not seem to be associated with poor sperm quality. In patients in clinical remission, male sexual function is not affected by IBD.
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19
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Garritsen F, van den Broek M, van Zuilen A, Fidder H, de Bruin-Weller M, Spuls P. Pregnancy and fetal outcomes after paternal exposure to azathioprine, methotrexate or mycophenolic acid: a critically appraised topic. Br J Dermatol 2017; 176:866-877. [DOI: 10.1111/bjd.15320] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- F.M. Garritsen
- Department of Dermatology; University Medical Center Utrecht; the Netherlands
| | - M.P.H. van den Broek
- Department of Clinical Pharmacy; University Medical Center Utrecht; the Netherlands
| | - A.D. van Zuilen
- Department of Nephrology; University Medical Center Utrecht; the Netherlands
| | - H.H. Fidder
- Department of Gastroenterology; University Medical Center Utrecht; the Netherlands
| | | | - P.I. Spuls
- Department of Dermatology; Academic Medical Center; University of Amsterdam; the Netherlands
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20
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Birth Outcomes in Children Fathered by Men Treated with Anti-TNF-α Agents Before Conception. Am J Gastroenterol 2016; 111:1608-1613. [PMID: 27619836 DOI: 10.1038/ajg.2016.405] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/01/2016] [Accepted: 07/06/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The safety of paternal use of anti-tumor necrosis factor-α (TNF-α) agents immediately prior to conception is practically unknown. On the basis of nationwide data from Danish health registries, we examined the association between paternal use of anti-TNF-α agents within 3 months before conception and adverse birth outcomes. METHODS This nationwide cohort study is based on data from all women who had a live born singleton child in Denmark from 1 January 2007 through 2013. Children fathered by men treated with anti-TNF-α agents within three months before conception constituted the exposed cohort (N=372), and children fathered by men not treated before conception constituted the unexposed cohort (N=399,498). The outcomes were congenital abnormalities (CAs), preterm birth, and small for gestational age (SGA). We adjusted for multiple covariates, and considered paternal underlying disease and concomitant medication. RESULTS The adjusted risks of CAs and preterm birth were close to unity, and the adjusted odds ratio (OR) for SGA was 1.70 (95% confidence interval (CI): 0.94-3.09). Restricting our analysis to fathers with inflammatory bowel disease, we found no increased risk of CAs or SGA, and the adjusted OR for pretem birth was 1.42 (95% CI: 0.52-3.86). Restricting our analysis to fathers with rheumatologic/dermatological diseases, we found no increased risk of CAs or preterm birth, and the adjusted OR for SGA was 1.70 (95% CI: 0.74-3.89). CONCLUSIONS Our results are overall reassuring regarding the safety of paternal preconceptional use of anti-TNF-α agents. The result regarding SGA should, however, be interpreted with caution as we found an increased risk, although not significantly increased.
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21
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Abstract
Crohn's disease and ulcerative colitis, referred to as inflammatory bowel disease (IBD), are chronic, relapsing conditions. Patients are often diagnosed at a reproductive age, and therefore questions about fertility and reproductions often arise. Preconceptional counseling is the most important aspect in the management of IBD patients with a pregnancy wish. Patients should be counseled on the influence of IBD and IBD drugs on pregnancy. Most drugs are not related to adverse outcome while used during pregnancy. Active disease is related to adverse outcomes; therefore, it is of utmost importance to strive for remission before conception and during pregnancy.
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Affiliation(s)
| | - C.J. van der Woude
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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22
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Shin T, Okada H. Infertility in men with inflammatory bowel disease. World J Gastrointest Pharmacol Ther 2016; 7:361-369. [PMID: 27602237 PMCID: PMC4986403 DOI: 10.4292/wjgpt.v7.i3.361] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/19/2016] [Accepted: 07/22/2016] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) predominantly affects young adults. Fertility-related issues are therefore important in the management of patients with IBD. However, relatively modest attention has been paid to reproductive issues faced by men with IBD. To investigate the effects of IBD and its treatment on male fertility, we reviewed the current literature using a systematic search for published studies. A PubMed search were performed using the main search terms “IBD AND male infertility”, “Crohn’s disease AND male infertility”, “ulcerative colitis AND male infertility”. References in review articles were used if relevant. We noted that active inflammation, poor nutrition, alcohol use, smoking, medications, and surgery may cause infertility in men with IBD. In surgery such as proctocolectomy with ileal pouch-anal anastomosis, rectal incision seems to be associated with sexual dysfunction. Of the medications used for IBD, sulfasalazine reversibly reduces male fertility. No other medications appear to affect male fertility significantly, although small studies suggested some adverse effects. There are limited data on the effects of drugs for IBD on male fertility and pregnancy outcomes; however, patients should be informed of the possible effects of paternal drug exposure. This review provides information on fertility-related issues in men with IBD and discusses treatment options.
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23
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Krause ML, Makol A. Management of rheumatoid arthritis during pregnancy: challenges and solutions. Open Access Rheumatol 2016; 8:23-36. [PMID: 27843367 PMCID: PMC5098768 DOI: 10.2147/oarrr.s85340] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Rheumatoid arthritis, a chronic inflammatory autoimmune disease with significant physical disability, affects women three times more frequently than men, often in their childbearing years. Parenthood decisions can be challenging, often affected by perceptions of their disease state, health care needs, and complex pharmacological treatments. Many women struggle to find adequate information to guide them on pregnancy planning, lactation, and early parenting in relation to their chronic condition. The expanded availability and choice of pharmacotherapies have supported optimal disease control prior to conception and enhanced physical capabilities for women to successfully overcome the challenges of raising children but require a detailed understanding of their risks and safety in the setting of pregnancy and breastfeeding. This review outlines the various situational challenges faced by rheumatologists in providing care to men and women in the reproductive age group interested in starting a family. Up to date evidence-based solutions particularly focusing on the safe use of disease-modifying antirheumatic drugs and biologic response modifiers to assist rheumatologists in the care of pregnant and lactating women with RA are reviewed.
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Affiliation(s)
- Megan L Krause
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, MN, USA
| | - Ashima Makol
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, MN, USA
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24
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Tiseo BC, Cocuzza M, Bonfá E, Srougi M, Clovis A. Male fertility potential alteration in rheumatic diseases: a systematic review. Int Braz J Urol 2016; 42:11-21. [PMID: 27120778 PMCID: PMC4811221 DOI: 10.1590/s1677-5538.ibju.2014.0595] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 09/17/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Improved targeted therapies for rheumatic diseases were developed recently resulting in a better prognosis for affected patients. Nowadays, patients are living longer and with improved quality of life, including fertility potential. These patients are affected by impaired reproductive function and the causes are often multifactorial related to particularities of each disease. This review highlights how rheumatic diseases and their management affect testicular function and male fertility. MATERIALS AND METHODS A systematic review of literature of all published data after 1970 was conducted. Data was collected about fertility abnormalities in male patients with systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, ankylosing spondylitis, Behçet disease and gout. Two independent researchers carried out the search in online databases. RESULTS A total of 19 articles were included addressing the following diseases: 7 systemic lupus erythematosus, 6 Behçet disease, 4 ankylosing spondylitis, 2 rheumatoid arthritis, 2 dermatomyositis and one gout. Systemic lupus erythematosus clearly affects gonadal function impairing spermatogenesis mainly due to antisperm antibodies and cyclophosphamide therapy. Behçet disease, gout and ankylosing spondylitis patients, including those under anti-TNF therapy in the latter disease, do not seem to have reduced fertility whereas in dermatomyositis, the fertility potential is hampered by disease activity and by alkylating agents. Data regarding rheumatoid arthritis is scarce, gonadal dysfunction observed as consequence of disease activity and antisperm antibodies. CONCLUSIONS Reduced fertility potential is not uncommon. Its frequency and severity vary among the different rheumatic diseases. Permanent infertility is rare and often associated with alkylating agent therapy.
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Affiliation(s)
- Bruno Camargo Tiseo
- Departamento de Urologia da Faculdade de Medicina da Universidade de São Paulo, Brasil
| | - Marcello Cocuzza
- Departamento de Urologia da Faculdade de Medicina da Universidade de São Paulo, Brasil
| | - Eloisa Bonfá
- Divisão de Reumatologia da Faculdade de Medicina da Universidade de São Paulo, Brasil
| | - Miguel Srougi
- Departamento de Urologia da Faculdade de Medicina da Universidade de São Paulo, Brasil
| | - A Clovis
- Divisão de Reumatologia da Faculdade de Medicina da Universidade de São Paulo, Brasil
- Unidade de Reumatologia Pediátrica do Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo, Brasil
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25
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Grunewald S, Jank A. New systemic agents in dermatology with respect to fertility, pregnancy, and lactation. J Dtsch Dermatol Ges 2015; 13:277-89; quiz 290. [PMID: 25819232 DOI: 10.1111/ddg.12596] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
With the increasing use of new, predominantly biologic drugs in dermatology, questions frequently arise in clinical practice as to their safety in women wishing to conceive as well as during pregnancy and lactation. Apart from the Summary of Product Characteristics and the Physician's Desk Reference, reliable information may be obtained from databases such as the one compiled by the Center for Pharmacovigilance and Consultation on Embryonal Toxicology at Charité University Medical Center Berlin (https://www.embryotox.de). Another source of information is researching recent publications, for example via PubMed (http://www.ncbi.nlm.nih.gov/pubmed). This article presents current knowledge from the sources mentioned above, and gives detailed information about the use of new biologic agents in women wishing to conceive as well as during pregnancy and lactation. Drugs reviewed include: infliximab, adalimumab, etanercept, metastatic for psoriasis, vemurafenib, dabrafenib, imatinib, ipilimumab for melanoma, vismodegib for basal cell carcinoma, rituximab for cutaneous lymphoma as well as omalizumab and anakinra used in the treatment of allergies.
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Affiliation(s)
- Sonja Grunewald
- Department of Dermatology, Venereology, and Allergology, University Hospital Leipzig
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26
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Grunewald S, Paasch U. [Drug treatment of dermatological disorders. Aspects to consider from an andrological perspective]. Hautarzt 2015; 66:913-8. [PMID: 26452356 DOI: 10.1007/s00105-015-3706-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dermatologists administer a broad spectrum of systemic medications. However, our current knowledge of potential risks to male fertility is still limited, particularly with the new emerging therapies in dermato-oncology. Individual differences in susceptibility and a history of andrological disorders influence prognostic values. For fertility protection, a thoughtful selection of medication and/or sperm cryopreservation remain the best options.
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Affiliation(s)
- S Grunewald
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Ph.-Rosenthal-Str. 23, 04103, Leipzig, Deutschland.
| | - U Paasch
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Ph.-Rosenthal-Str. 23, 04103, Leipzig, Deutschland
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27
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Sands K, Jansen R, Zaslau S, Greenwald D. Review article: the safety of therapeutic drugs in male inflammatory bowel disease patients wishing to conceive. Aliment Pharmacol Ther 2015; 41:821-34. [PMID: 25752753 DOI: 10.1111/apt.13142] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 04/27/2013] [Accepted: 02/05/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Many therapeutic drugs are used by patients with inflammatory bowel disease, often around the time of conception. The pregnancy outcomes of males and females exposed to these therapeutics needs to be examined and this information is necessary to counsel patients appropriately. AIM To review the literature describing male infertility and inflammatory bowel disease to educate practitioners of the impact of inflammatory bowel disease on male reproduction and the impact of therapeutics on pregnancy outcomes. METHODS We performed a PubMed search using the search terms 'male infertility,' 'Crohn's disease,' 'inflammatory bowel disease,' 'ulcerative colitis,' 'ciprofloxacin AND infertility,' 'metronidazole AND infertility,' 'sulfasalazine AND infertility,' 'azathioprine AND infertility,' 'methotrexate AND infertility,' 'ciclosporin AND infertility,' 'corticosteroids AND infertility,' 'infliximab AND male fertility,' 'infliximab AND infertility,' 'infliximab AND foetus,' 'infliximab AND paternal exposure' and 'infliximab AND sperm.' References from selected papers were reviewed and used if relevant. RESULTS Over half of male patients with IBD have some degree of infertility, compared to 8-17% of the general population. Semen parameters including total count, motility and morphology may be adversely affected by therapeutics. IBD medications in males do not increase foetal risk with the possible exception of azathioprine and mercaptopurine; however, increased foetal risk is seen in other drugs if taken by female patients. CONCLUSIONS It is recognised that male infertility is often impacted with therapeutic drugs used to treat inflammatory bowel disease; however, the effects of the paternal drug exposure at the time of conception and exposure in utero should be considered to counsel patients appropriately.
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Affiliation(s)
- K Sands
- EW Sparrow Hospital Urology Residency, Michigan State University College of Osteopathic Medicine, Lansing, MI, USA
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28
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Grunewald S, Jank A. Neue dermatologische Systemtherapien bei Kinderwunsch, Schwangerschaft und Stillzeit. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12596_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Sonja Grunewald
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR
| | - Alexander Jank
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig AöR
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29
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Schulze H, Esters P, Dignass A. Review article: the management of Crohn's disease and ulcerative colitis during pregnancy and lactation. Aliment Pharmacol Ther 2014; 40:991-1008. [PMID: 25200000 DOI: 10.1111/apt.12949] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 02/24/2014] [Accepted: 08/14/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) commonly affect young patients in the reproductive phase of their lives. The chronic and relapsing nature of IBD and the potential need for medical or surgical interventions raise concerns about family planning issues. AIM To review the current knowledge on IBD management in pregnant and nursing IBD patients. METHODS A PubMed literature search was performed using the search terms 'reproduction' and 'inflammatory bowel disease' and using the headers and main subjects of each section of this article as search terms. RESULTS Male and female fertility are not impaired in the majority of IBD patients. In IBD patients with quiescent disease pregnancy outcomes are not impaired in comparison to the general population, however, an increased incidence of pregnancy complications is observed in active IBD patients. As methotrexate (MTX) has been demonstrated to be teratogenic, the use of MTX is contraindicated in patients, who wish to conceive, throughout pregnancy and when nursing. However, normal pregnancies following MTX treatment at conception and later have been reported. Most of the other currently approved IBD medications are not associated with adverse pregnancy outcomes and may be used to maintain quiescent disease or to induce a rapid remission in patients with flares and active disease. Breast-feeding in IBD patients is possible and recommended. CONCLUSIONS The overall outcome of pregnancies in IBD patients is favourable and not different to healthy controls, thus patients with IBD should not be discouraged from having children.
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Affiliation(s)
- H Schulze
- Department of Medicine I - Gastroenterology, Hepatology, Oncology and Nutrition, Agaplesion Markus Hospital, Goethe University, Frankfurt, Germany
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30
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Krause ML, Amin S, Makol A. Use of DMARDs and biologics during pregnancy and lactation in rheumatoid arthritis: what the rheumatologist needs to know. Ther Adv Musculoskelet Dis 2014; 6:169-84. [PMID: 25342996 DOI: 10.1177/1759720x14551568] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rheumatoid arthritis (RA), a chronic autoimmune inflammatory disease of synovial joints, can lead to chronic pain and structural joint damage, as well as other organ involvement, especially if not adequately controlled. Because it can affect women in their reproductive years, care of pregnant women with RA requires a delicate balance of maintaining disease control while limiting potential toxicity to the fetus and neonate. While most women experience a substantial improvement in disease activity during pregnancy, for some women their RA remains active. It can even manifest itself for the first time during pregnancy or early in the post-partum period. Optimizing disease control prior to conception is key, but utilizing disease-modifying treatments effectively and safely throughout pregnancy and lactation requires open dialogue and shared decision making. This review provides evidence-based recommendations for use of disease-modifying antirheumatic drugs (DMARDs) and biologic response modifiers to guide rheumatologists in their care of pregnant and lactating women with RA and serves as a guide to counsel male patients with RA on family planning decisions.
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Affiliation(s)
- Megan L Krause
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Shreyasee Amin
- Division of Rheumatology, Department of Internal Medicine; and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Ashima Makol
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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31
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Yiu ZZN, Griffiths CEM, Warren RB. Safety of biological therapies for psoriasis: effects on reproductive potential and outcomes in male and female patients. Br J Dermatol 2014; 171:485-91. [PMID: 24749725 DOI: 10.1111/bjd.13060] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 02/06/2023]
Abstract
The effects of biological therapies for psoriasis on pregnancy outcomes and lactation, and male fertility and mutagenicity are common concerns in the clinical setting. There is relatively little evidence to guide the clinician and patient. Here, we review the safety profile of the commonly used biological therapies for psoriasis in individuals of reproductive potential. Safety data were derived from large-scale registries, adverse event reporting databases, clinical trials and case reports. We assessed the effect of each therapy on adverse pregnancy outcomes including congenital malformations, and lactation with maternal administration, and male fertility and potential mutagenicity with paternal administration. We provide applicable guidance to inform clinician and patient before and after conception.
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Affiliation(s)
- Z Z N Yiu
- The Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, M6 8HD, U.K
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Reply to the comment “Effect of Infliximab on Male Fertility” by Younis et al. Joint Bone Spine 2014; 81:103. [DOI: 10.1016/j.jbspin.2013.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2013] [Indexed: 11/18/2022]
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Effect of infliximab on male fertility: Comment on the article “Fertility in male patients with seronegative spondyloarthropathies treated with infliximab” by Saougou et al., Joint Bone Spine 2013;80, 34–37. Joint Bone Spine 2014; 81:102-3. [DOI: 10.1016/j.jbspin.2013.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/07/2013] [Indexed: 11/21/2022]
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Ramonda R, Foresta C, Ortolan A, Bertoldo A, Oliviero F, Lorenzin M, Pizzol D, Punzi L, Garolla A. Influence of tumor necrosis factor α inhibitors on testicular function and semen in spondyloarthritis patients. Fertil Steril 2013; 101:359-65. [PMID: 24332378 DOI: 10.1016/j.fertnstert.2013.10.048] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/27/2013] [Accepted: 10/29/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate sperm parameters and sexual hormones in young males affected with spondyloarthritis (SpA) before and after 1 year of anti-tumor necrosis factor (TNF) α treatment. DESIGN Prospective case-control study. SETTING Rheumatology and human reproduction pathology units at a university hospital. PATIENTS Ten SpA outpatients attending the rheumatology clinic; 20 healthy control subjects attending the unit of human reproduction pathology within an infertility prevention program. INTERVENTIONS At baseline and after a 12-month treatment, disease activity was assessed and an andrologic evaluation made. MAIN OUTCOME MEASURE(S) Rheumatologists assessed anamnestic, clinical, functional, and biomarker data. Andrologists evaluated semen analysis, fluorescence in situ hybridization for chromosomes X, Y, 13, 18, and 21, FSH, LH, and T plasma levels, and testicular color Doppler ultrasound. RESULTS At baseline, SpA patients showed reduced sperm motility, higher plasma LH and FSH, and lower T levels compared with control subjects; a significant correlation between disease activity and sperm quality was found. After treatment, a statistically significant decrease in sperm aneuploidies and normal hormone levels were observed. CONCLUSIONS Although inflammation in SpA appears to be related to impaired testicular function, anti-TNF-α agents seem to be safe on testicular function and fertility.
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Affiliation(s)
- Roberta Ramonda
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Carlo Foresta
- Unit of Human Reproduction Pathology, Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Alessandro Bertoldo
- Unit of Human Reproduction Pathology, Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Francesca Oliviero
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | | | - Damiano Pizzol
- Unit of Human Reproduction Pathology, Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Andrea Garolla
- Unit of Human Reproduction Pathology, Department of Molecular Medicine, University of Padua, Padua, Italy.
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Millsop JW, Heller MM, Eliason MJ, Murase JE. Dermatological medication effects on male fertility. Dermatol Ther 2013; 26:337-46. [DOI: 10.1111/dth.12069] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Mark J. Eliason
- Department of Dermatology; University of Utah; Salt Lake City; Utah
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Nukumizu LA, Saad CG, Ostensen M, Almeida BP, Cocuzza M, Gonçalves C, Saito O, Bonfá E, Silva CA. Gonadal function in male patients with ankylosing spondylitis. Scand J Rheumatol 2012; 41:476-81. [DOI: 10.3109/03009742.2012.688218] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fertility in male patients with seronegative spondyloarthropathies treated with infliximab. Joint Bone Spine 2012; 80:34-7. [PMID: 22575067 DOI: 10.1016/j.jbspin.2012.03.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 03/12/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The majority of patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are affected during their peak reproductive years. Tumor necrosis factor (TNF)α plays a pivotal role in the pathogenesis of both diseases. Today, anti-TNFα blockers are an essential treatment for these patients. To identify male patients who achieved pregnancy development during their management with anti-TNFα blockers (infliximab). METHODS We reviewed the data of 65 patients with AS and 30 patients with PsA who were followed-up in our rheumatology outpatients clinic and they were on infliximab therapy between January 2001 and December 2010. RESULTS We identified overall seven male patients with AS and three male patients with PsA who had fathered 14 healthy infants. Moreover, we recognized one man with PsA who was on infliximab and on concomitant therapy with MTX at the time of conception, whose wife had to proceed to therapeutic abortion due to congenital abnormalities of the fetus (hydrocephalia), while she was on the first trimester of pregnancy. CONCLUSIONS We described male patients with AS and PsA who demonstrated no fertility problems while they were on infliximab treatment. The data designated in this report provide some supportive evidence for the safe use of infliximab in male patients who are affected of those inflammatory diseases during their peak reproductive years.
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Consensus Statement of the Spanish Society of Rheumatology on Risk Management of Biologic Therapy in Rheumatic Patients. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.reumae.2011.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Reino JG, Loza E, Andreu JL, Balsa A, Batlle E, Cañete JD, Collantes Estévez E, Fernández Carballido C, Fernández Sueiro JL, García de Vicuña R, González-Álvaro I, González Fernández C, Juanola X, Linares LF, Marenco JL, Martín Mola E, Moreno Ramos M, Mulero Mendoza J, Muñoz Fernández S, Queiro R, Richi Alberti P, Sanz J, Tornero Molina J, Zarco Montejo P, Carmona L. Consenso SER sobre la gestión de riesgo del tratamiento con terapias biológicas en pacientes con enfermedades reumáticas. ACTA ACUST UNITED AC 2011; 7:284-98. [DOI: 10.1016/j.reuma.2011.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 05/04/2011] [Accepted: 05/04/2011] [Indexed: 12/16/2022]
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Abstract
Over the past years, biological therapies, especially anti-TNF-α antibody therapy has emerged as a treatment approach in patients who have failed to achieve or maintain remission with tradional DMARDs. Women suffering from inflammatory arthritis may need to continue therapy throughout pregnancy and/or in the lactation period, hence the increased concern over the safety of antirheumatic drugs during pregnancy. Anti-TNF agents fall within the US FDA category B concerning fetal risk, indicating that no adequate and well-controlled studies have been conducted in pregnant or lactating women. However, in the last decade, numerous case series and registry data of pregnancies exposed to anti-TNF therapy have accumulated in the literature. According to these data, TNF inhibitor therapies appear to be safe in pregnancy, since no increased risk of malformations has been demonstrated. Ceasing therapy after conception should be considered, but treatment may be continued during pregnancy when indicated.The use of these agents is likely compatible with breast-feeding. The extent of fetal risk is not clarified for exposure to other biologics, such as Rituximab.
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Affiliation(s)
- R E Fischer-Betz
- Klinik für Endokrinolologie, Diabetologie und Rheumatologie, Rheumazentrum Rhein-Ruhr, Moorenstr. 5, 40225, Düsseldorf.
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LAHITA ROBERTG, VERNACE MELCHIOREA. Vasculitis, Vitiligo, Thyroiditis, and Altered Hormone Levels After Anti-Tumor Necrosis Factor Therapy. J Rheumatol 2011; 38:579-80. [DOI: 10.3899/jrheum.100968] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Beghin D, Cournot MP, Vauzelle C, Elefant E. Paternal exposure to methotrexate and pregnancy outcomes. J Rheumatol 2011; 38:628-32. [PMID: 21239747 DOI: 10.3899/jrheum.100600] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess the risk of major malformation in the case of paternal exposure to methotrexate (MTX) at the time of conception. METHODS Using prospective data of our Teratology Information Service, we analyzed outcomes of paternal MTX exposure at the time of conception or up to 3 months before conception. RESULTS We report on the outcomes of 42 pregnancies involving 40 men treated with MTX at the time of conception. Twenty-three men were treated for an inflammatory disease (54.8%), 9 for psoriasis (21.4%), and 8 for a malignant disease (19.0%). Weekly dosages varied between 7.5 mg and 30 mg. The pregnancies resulted in 36 live births, 3 spontaneous abortions, and 3 voluntary abortions. No congenital malformation was observed at birth. CONCLUSION Based on our results and case reports in literature, paternal MTX exposure at the time of conception does not seem to raise any major concern for offspring.
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Affiliation(s)
- Delphine Beghin
- Centre de Référence sur les Agents Tératogènes (CRAT), Hôpital Armand Trousseau, Groupe Universitaire Est, Paris, France
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Silva CA, Bonfa E, ØStensen M. Maintenance of fertility in patients with rheumatic diseases needing antiinflammatory and immunosuppressive drugs. Arthritis Care Res (Hoboken) 2010; 62:1682-90. [DOI: 10.1002/acr.20323] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Miehsler W, Novacek G, Wenzl H, Vogelsang H, Knoflach P, Kaser A, Dejaco C, Petritsch W, Kapitan M, Maier H, Graninger W, Tilg H, Reinisch W. A decade of infliximab: The Austrian evidence based consensus on the safe use of infliximab in inflammatory bowel disease. J Crohns Colitis 2010; 4:221-56. [PMID: 21122513 DOI: 10.1016/j.crohns.2009.12.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 12/01/2009] [Indexed: 12/15/2022]
Abstract
Infliximab (IFX) has tremendously enriched the therapy of inflammatory bowel diseases (IBD) and other immune mediated diseases. Although the efficacy of IFX was undoubtedly proven during the last decade numerous publications have also caused various safety concerns. To summarize the immense information concerning adverse events and safety issues the Austrian Society of Gastroenterology and Hepatology launched this evidence based consensus on the safe use of IFX which covers the following topics: infusion reactions and immunogenicity, skin reactions, opportunistic infections (including tuberculosis), non-opportunistic infections (bacterial and viral), vaccination, neurological complications, hepatotoxicity, congestive heart failure, haematological side effects, intestinal strictures, stenosis and bowel obstruction (SSO), concomitant medication, malignancy and lymphoma, IFX in the elderly and the young, mortality, fertility, pregnancy and breast feeding. To make the vast amount of information practicable for routine application the consensus was finally condensed into a checklist for a safe use of IFX which consists of two parts: issues to be addressed prior to anti-TNF therapy and issues to be addressed during maintenance. Both parts are further divided into obligatory and facultative items.
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Affiliation(s)
- W Miehsler
- Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria.
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Zrour-Hassen S, Jguirim M, Aouam K, Korbaa W, Younes M, Bejia I, Touzi M, Bergaoui N. Sécurité des médicaments à usage rhumatologique en âge de procréation. Therapie 2010; 65:465-73. [DOI: 10.2515/therapie/2010061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 07/06/2010] [Indexed: 12/16/2022]
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Clowse MEB. The use of anti-TNFα medications for rheumatologic disease in pregnancy. Int J Womens Health 2010; 2:199-209. [PMID: 21072312 PMCID: PMC2971732 DOI: 10.2147/ijwh.s6029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Indexed: 12/19/2022] Open
Abstract
Anti-TNFα medications have led to vast improvements in the treatment of inflammatory conditions, including rheumatoid arthritis and Crohn's disease. As these diseases often afflict women in their reproductive years, the safety of these drugs during pregnancy is an important issue. Prospectively collected data thus far appear to be reassuring; however an analysis of the FDA-reported anomalies has raised some questions. It appears that significant levels of these drugs cross the placenta as the pregnancy nears term, but little is passed through breast milk. Prior to using these medications during pregnancy, the risks and benefits of these drugs, other treatment options, and the ongoing inflammatory condition all must be carefully weighed by both doctor and patient.
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Affiliation(s)
- Megan EB Clowse
- Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Martineau M, Haskard DO, Nelson-Piercy C. Behçet's syndrome in pregnancy. Obstet Med 2010; 3:2-7. [PMID: 27582833 PMCID: PMC4989763 DOI: 10.1258/om.2009.090033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2009] [Indexed: 12/16/2022] Open
Abstract
Behçet's syndrome (BS), a systemic inflammatory disease characterized by oral and genital ulceration, eye inflammation and arthritis, usually presents in the third and fourth decades of life, but is rare in pregnancy. BS is not usually associated with a detrimental effect on pregnancy outcome. In most women BS is reported to improve in pregnancy, although it may not always follow a similar course in successive pregnancies and it is not possible to predict the course of BS in a particular pregnancy. Many of the drug therapies used to treat BS are safe to use in pregnancy and in the breastfeeding mother. These include corticosteroids, azathioprine, calcineurin inhibitors and probably colchicine. Experience with use of biologics in pregnancy is increasing. Drugs used in the management of BS that should be avoided in women planning a pregnancy include methotrexate, mycophenolate mofetil, thalidomide, cyclophosphamide and chlorambucil.
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Affiliation(s)
- Marcus Martineau
- Guy's & St Thomas' Foundation Trust, Westminster Bridge Road, London SE1 7EH
| | | | - Catherine Nelson-Piercy
- Guy's & St Thomas' Foundation Trust, Westminster Bridge Road, London SE1 7EH
- Imperial College Healthcare Trust, Imperial College London, UK
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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