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Flatman LK, Malhamé I, Colmegna I, Bérard A, Bernatsky S, Vinet É. Tumour necrosis factor inhibitors and serious infections in reproductive-age women and their offspring: a narrative review. Scand J Rheumatol 2024:1-12. [PMID: 38314746 DOI: 10.1080/03009742.2024.2303832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024]
Abstract
Tumour necrosis factor inhibitors (TNFi) are commonly used to treat patients with chronic inflammatory diseases, and function by inhibiting the pro-inflammatory cytokine tumour necrosis factor-α (TNF-α). Although beneficial in reducing disease activity, they are associated with an increased risk of serious infections. Data on the risk of serious infections associated with TNFi use during the reproductive years, particularly in pregnancy, are limited. For pregnant women, there is an additional risk of immunosuppression in the offspring as TNFi can be actively transported across the placenta, which increases in the second and third trimesters. Several studies have explored the risk of serious infections with TNFi exposure in non-pregnant and pregnant patients and offspring exposed in utero, indicating an increased risk in non-pregnant patients and a potentially increased risk in pregnant patients. The studies on TNFi-exposed offspring showed conflicting results between in utero TNFi exposure and serious infections during the offspring's first year. Further research is needed to understand differential risks based on TNFi subtypes. Guidelines conditionally recommend the rotavirus vaccine before 6 months of age for offspring exposed to TNFi in utero, but more data are needed to support these recommendations because of limited evidence. This narrative review provides an overview of the risk in non-pregnant patients and summarizes evidence on how pregnancy can increase vulnerability to certain infections and how TNFi may influence this susceptibility. This review focuses on the evidence regarding the risk of serious infections in pregnant patients exposed to TNFi and the risk of infections in their offspring.
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Affiliation(s)
- L K Flatman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - I Malhamé
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - I Colmegna
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - A Bérard
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Medicine, Université Claude Bernard Lyon 1, Lyon, France
| | - S Bernatsky
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Rheumatology, Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - É Vinet
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Rheumatology, Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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Mendel A, Fritzler MJ, St-Pierre Y, Rauch J, Bernatsky S, Vinet É. Outcomes associated with antiphospholipid antibodies in COVID-19: A prospective cohort study. Res Pract Thromb Haemost 2023; 7:100041. [PMID: 36644653 PMCID: PMC9825139 DOI: 10.1016/j.rpth.2023.100041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/24/2022] [Accepted: 11/05/2022] [Indexed: 01/09/2023] Open
Abstract
Background The significance of antiphospholipid antibodies (aPL) in COVID-19 remains uncertain. Objectives We determined whether aPL are associated with COVID-19 and/or thrombosis or adverse outcomes during hospitalization for COVID-19. Methods Symptomatic adults tested for SARS-CoV-2 for clinical reasons (March-July 2020) with either ≥1 positive polymerase chain reaction (COVID-19+) or all negative (non-COVID-19) results were recruited to a biobank collecting plasma, clinical data, and outcomes. We tested baseline plasma samples (days 0-7) of all subjects (and day-30 samples in the COVID-19+ subjects, when available) for aPL (anticardiolipin immunoglobulin [Ig]M/IgG, anti-β2-glycoprotein I IgM/IgG, antiphosphatidylserine/prothrombin IgM/IgG, and lupus anticoagulant). We compared the baseline prevalence of aPL between the COVID-19+ and non-COVID-19 subjects. Among hospitalized COVID-19+ subjects, multivariable logistic regression was used to evaluate the association of aPL (and their subtypes) with arterial or venous thromboembolic events, acute kidney injury, intensive care unit admission, mechanical ventilation, and death after adjusting for potential confounders. Results At baseline, 123 of 289 (43%) COVID+ subjects had ≥1 aPL versus 116 of 261 (32%) non-COVID-19 subjects (difference, 10%; 95% CI, 3%-18%). Among 89 COVID+ subjects with repeated samples, aPL persisted on day 30 in 15 of 34 (44%) subjects with baseline aPL positivity, and half of those without aPL at baseline developed one or more new aPL. In hospitalized COVID-19 subjects (n = 241), baseline aPL positivity was associated with acute kidney injury (odds ratio [OR], 1.8; 95% CI, 1.1-3.2) and mechanical ventilation (OR, 3.2; 95% CI, 1.5-6.8) but not death (OR, 1.2; 95% CI, 0.6-2.5). In secondary analyses, medium-to-high titers of anticardiolipin IgG (>40) were associated with thromboembolic events (OR, 7.3; 95% CI, 1.8-30.1). Conclusion In patients with COVID-19, aPL may help identify an increased risk of thrombosis and other adverse outcomes.
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Affiliation(s)
- Arielle Mendel
- Division of Rheumatology, McGill University Health Centre, Montreal, Canada,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Canada,Correspondence Arielle Mendel, Division of Rheumatology, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, H3G1A4, Canada
| | - Marvin J. Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yvan St-Pierre
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Joyce Rauch
- Division of Rheumatology, McGill University Health Centre, Montreal, Canada,Centre for Translational Biology, Research Institute of the Mcgill University Health Centre, Montreal, Canada
| | - Sasha Bernatsky
- Division of Rheumatology, McGill University Health Centre, Montreal, Canada,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Évelyne. Vinet
- Division of Rheumatology, McGill University Health Centre, Montreal, Canada,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Canada
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Berard A, Lacasse A, Gomez YH, Gorgui J, Côté S, King S, Tchuente V, Muanda F, Lumu Y, Boucoiran I, Nuyt AM, Quach C, Ferreira E, Kaul P, Winquist B, O’Donnell K, Eltonsy S, Château D, Zhao JP, Hanley G, Oberlander T, Kassai B, Mainbourg S, Bernatsky S, Vinet É, Brodeur-Doucet A, Demers J, Richebé P, Zaphiratos V, Wang C, Wang X. Impact of the COVID-19 pandemic on maternal mental health during pregnancy: The CONCEPTION study – Phase I. Eur Psychiatry 2022. [PMCID: PMC9564943 DOI: 10.1192/j.eurpsy.2022.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Mental health regional differences during pregnancy through the COVID-19 pandemic is understudied. Objectives We aimed to quantify the impact of the COVID-19 pandemic on maternal mental health during pregnancy. Methods A cohort study with a web-based recruitment strategy and electronic data collection was initiated in 06/2020. Although Canadian women, >18 years were primarily targeted, pregnant women worldwide were eligible. The current analysis includes data on women enrolled 06/2020-11/2020. Self-reported data included mental health measures (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7)), stress. We compared maternal mental health stratifying on country/continents of residence, and identified determinants of mental health using multivariable regression models. Results Of 2,109 pregnant women recruited, 1,932 were from Canada, 48 the United States (US), 73 Europe, 35 Africa, and 21 Asia/Oceania. Mean depressive symptom scores were lower in Canada (EPDS 8.2, SD 5.2) compared to the US (EPDS 10.5, SD 4.8) and Europe (EPDS 10.4, SD 6.5) (p<0.05), regardless of being infected or not. Maternal anxiety, stress, decreased income and access to health care due to the pandemic were increasing maternal depression. The prevalence of severe anxiety was similar across country/continents. Maternal depression, stress, and earlier recruitment during the pandemic (June/July) were associated with increased maternal anxiety. Conclusions In this first international study on the impact of the COVID-19 pandemic, CONCEPTION has shown significant country/continent-specific variations in depressive symptoms during pregnancy, whereas severe anxiety was similar regardless of place of residence. Strategies are needed to reduce COVID-19’s mental health burden in pregnancy. Disclosure No significant relationships.
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Vinet É, Pineau CA, Clarke AE, Fombonne É, Platt RW, Bernatsky S. Neurodevelopmental disorders in children born to mothers with systemic lupus erythematosus. Lupus 2014; 23:1099-104. [PMID: 24969080 DOI: 10.1177/0961203314541691] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Children born to women with systemic lupus erythematosus seem to have a potentially increased risk of neurodevelopmental disorders compared to children born to healthy women. Recent experimental data suggest in utero exposure to maternal antibodies and cytokines as important risk factors for neurodevelopmental disorders. Interestingly, women with systemic lupus erythematosus display high levels of autoantibodies and cytokines, which have been shown, in animal models, to alter fetal brain development and induce behavioral anomalies in offspring. Furthermore, subjects with systemic lupus erythematosus and neurodevelopmental disorders share a common genetic predisposition, which could impair the fetal immune response to in utero immunologic insults. Moreover, systemic lupus erythematosus pregnancies are at increased risk of adverse obstetrical outcomes and medication exposures, which have been implicated as potential risk factors for neurodevelopmental disorders. In this article, we review the current state of knowledge on neurodevelopmental disorders and their potential determinants in systemic lupus erythematosus offspring.
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Affiliation(s)
- É Vinet
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada Division of Rheumatology, McGill University Health Centre, Montreal, Canada
| | - C A Pineau
- Division of Rheumatology, McGill University Health Centre, Montreal, Canada
| | - A E Clarke
- Division of Rheumatology, University of Calgary, Calgary, Canada
| | - É Fombonne
- Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, USA
| | - R W Platt
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada
| | - S Bernatsky
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada Division of Rheumatology, McGill University Health Centre, Montreal, Canada
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