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Breastfeeding while on Humira vs Live Vaccines

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  • Breastfeeding while on Humira vs Live Vaccines

    Hello,

    I am Crohns and Spondylitis patient. I stopped using Humira in the third trimester of pregnancy, but I have been on Humira for the last 6 months, and breastfeeding. Although many doctors opposed it, I breastfed trusting the information I got from InfantRisk that it passes to infant in very low doses. My son is 11 months old and he should be getting his live vaccines soon by schedule. I want to learn if there is a risk to the infant because his immune system is compromised and live vaccines infect him? Should I postpone live vaccines, and if so when should my son have them?

    Regards,
    Figen

  • #2
    Figen Vasileva,

    Has your son been tested and found to be immunocompromised, or do you just think he is because of the Humira? If he is doing well and not immunocompromised we would say he could go ahead and get his live vaccines as scheduled. If he has been tested and is known to be immunocompromised we would suggest you start weaning now then waiting until his immune system is back to normal and then he could receive his live vaccines. We recommend that you can continue to nurse as long as your infant is not symptomatic, but immunodeficiency is a negative side effect that would be considered a reason to discontinue nursing.

    If you have any further questions please call the InfantRisk Center.

    Sandra Lovato R.N.
    InfantRisk Center
    806-352-2519

    Comment


    • #3
      Dear Sandra,

      I didnt know 'immunocomprimised' can be tested. (Can you tell us the test name, so that we pass this information to our pediatrician?) My son is not showing any symptoms, but we want to be sure.

      Thank you,

      Regards,
      Figen
      Last edited by Figen Vasileva; 03-29-2018, 09:16 AM.

      Comment


      • #4
        Figen Vasileva,

        Please call the InfantRisk Center 806-352-2519.

        Comment


        • #5

          Figen Vasileva,

          If your infant is not sick all the time, and is gaining weight appropriately it is unlikely they are immunocompromised. A simple CBC to see that their blood count is normal should be sufficient, but probably not necessary.

          Sandra Lovato

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          • #6
            Sandra: is immunecompromise a side effect of Humira for breastfed babies?

            Comment


            • #7
              annieandy,

              Very little of Humira transfers into breast milk, only 0.12% of your dose. We believe it is a low risk for infants exposed through breast milk alone, but a slightly increased risk when infants are exposed during pregnancy (especially the third trimester) and then again through breast milk. "Although the molecular weight of this medication is very large and the amount in breastmilk is very low, there are no long term data concerning the safety of using immune modulating medications in breastfeeding mothers. Further there are current data that suggest that some IgG drugs do transfer into milk, and perhaps the breastfed infant. Therefore, some caution is recommended and each woman should understand the benefits and risk of using this type of medication in lactation." (Medications and Mothers' Milk database, Dr Thomas Hale PhD).

              Sandra Lovato R.N.
              InfantRisk Center
              806-352-2519

              Comment


              • #8
                Hello Sandra,

                Isnt this a contradicting information from your previous post? You had said we can breastfeed safely, now saying we should be cautious. "Further there are current data that suggest that some IgG drugs do transfer into milk, and perhaps the breastfed infant." Is this included in the 0.12%, or that number is meaningless?

                I had asked about breastfeeding while on Humira and you replied as follows:


                11-14-2017, 09:49 AM
                Figen Vasileva,

                Humira has a very low transfer rate. We advise that even young infants can continue to breastfeed as long as they are not symptomatic. Monitor for vomiting, fever, weight gain, and frequent infections.

                This is Dr Hales previous post:

                "By no means stop breastfeeding. We do have some data on Humira which suggests its transfer into human milk is very low with a relative infant dose of only 0.12%. This is exceedingly low. Even this amount present in the babies gut, would be largely metabolized like any other protein, and not really absorbed systemically to any degree.

                Studies in two infants suggested levels in milk were negligible and of no consequence.

                Tom Hale R.Ph., Ph.d."

                Sandra Lovato R.N.
                InfantRisk Center
                806-352-2519

                Comment


                • #9
                  Figen Vasileva,

                  We believe taking Humira is a very low risk due to the low transfer rate of 0.12%, but with any medication we advise to observe your infant for any of the possible side effects. If your infant is not symptomatic they are not receiving enough to affect them. We cannot say any medication is without risk, even Tylenol and vitamins if taken in supratherapeutic doses can be dangerous. If you look at the sentences prior to the one you are quoting it states we believe it is low risk.

                  Sandra

                  Comment


                  • #10
                    Thank you,

                    My apologies, I correct myself, you didnt say safe but low risk.

                    I was focusing on this information "Further there are current data that suggest that some IgG drugs do transfer into milk, and perhaps the breastfed infant." This sounded to me like an update that humira goes into breast milk more than previously stated 0.12 %. But I should have understood it as an explanation of 0.12%.

                    Our son could be building some disease from the long list of humira side effects which make take a few years to surface. He is not symptomatic now, but we are not sure what is really happening in the long term.

                    We were aware of the risks and we took it, I just wanted to understand if there is an update about the 0.12%. I guess the percentage is calculated based on weight. So around 5% in his system would be critical, right? I am trying to understand the scale.

                    Thanks for your help and time.
                    Figen

                    Comment


                    • #11
                      Figen:

                      The highest concentrations of ADALIMUMAB occur before birth during pregnancy. In the last trimester, significant amounts of IgG are known to transfer. I don't know if you used it while pregnant, but the levels via milk are miniscule compared to in-utero. Most is probably denatured by proteases in the gut long before it could potentially be absorbed anyway.

                      We have a bunch of these monoclonal antibody-like drugs in use today. Thus far, I have yet to hear of any complications in a breastfed infant.

                      I would not worry about your situation. 0.12% is so low that I can't imagine it would ever produce a clinical effect in a breastfed infant. Most of this is probably metabolized in the stomach and intestiine and is unabsorbed, like any other large molecular weight protein.


                      Tom Hale PhD.
                      InfantRisk Center

                      Comment


                      • #12
                        Hello again,

                        I have been breasfeeding my son while on Humira. My doctor said he is going to change my medication to adalimumab-atto (amjevita). Does the same principles apply as Humira? I understand it has a different formation process? Can I still breastfeed? (I dont know if you have conducted research on it, as it is publicly available from 2023 in US)

                        My son:
                        19 months old
                        11.5 kgs

                        Best Regards
                        Figen

                        * I am sorry if this is a duplicate post, my previous post in not listed here.

                        Comment


                        • #13
                          Figen:

                          Amjevita is what we call a biosimilar. Supposedly works just like Humira. I'm sure it is just fine to breastfeed with this new, cheaper product.

                          Tom Hale Ph.D.

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