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Infliximab, breastfeeding and oral bioavailability

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  • Infliximab, breastfeeding and oral bioavailability

    Hello,

    I am curious about your take on infliximab and breastfeeding. I understand that the RID of infliximab is 0.3-0.7%. I also understand that infliximab should have low bioavailability in the gut (given that it is given by infusion for that reason). I am curious, however, about the findings from the Fritzsche study (see link below). This was a case series that studied the presence of infliximab in breastfed infants. In one of their mother-child pairs, they found an infant infliximab level of 1700ng/mL (Fritzsche et al, Infliximab and Adalimumab Use During Breastfeeding). It is somewhat hard to figure out the timing of this serum measurement but it seems that this test was performed 38 weeks postpartum (the first test was performed at 34 weeks and the second test 4 weeks later), at which time I would imagine that infliximab levels from pregnancy would be undetectable. This appears to be the only case report of detectable serum levels in an infant that are attributable to breastfeeding, but I was hoping I could get your take on this. The paper muses about possible uptake via the Fc receptor in the infant gut.

    On the advice of my gastroenterologist, I have been breastfeeding my baby. I understand also that you consider this medication to be safe, and with a very low RID. I'd be interested, however, to hear your take on this.

    Sincerely,

    Jess
    Last edited by thisisfudd; 11-06-2015, 09:46 PM.

  • #2
    While the 1700 ng/mL sounds extensive, it is nothing compared to that delivered to the infant in the last trimester of pregnancy. I agree that this is the only report that actually finds plasma levels of this drug in infants, which is 'interesting'. I have some concern about the assay methodology used as I've had trouble using elisa assays on human milk without doing extensive lipid extraction.

    So at this point, we don't really know what is accurate about the transfer of this drug into human milk. While it is true that there is apparently an FcRn transporter in the gut of humans, we don't know anything about its presence in infants, nor how active this transporter is in the gut of humans.

    So, at this point, the infant is still be better off ingesting human milk with slight levels of infliximab, as opposed to the noxious problems associated with formulas.

    Tom Hale Ph.D.
    InfantRisk Center

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