RA taking HUMIRA and Prednisone

[osnatn]

Hello,
my sister is currently 8 months pregnant, 1st child and has JRA and Uveitis. She has been advised to do a C/S due to an ahmed valve implant in her eye and 2 failed trabeculectomies (due to glaucoma, now stable).
She takes 40 mg HUMIRA every 2 weeks, 5 mg prednisone daily.
Her doctors don't know if she can breastfeed. Reading your forum I understand that she can BF her baby only one week after delivery, pumping and dumping the whole week.
Please advise the correct treatment regime:
High dose prednisone one day pre-op;
Humira injections: 2 weeks pre-op, week after delivery, then every 2 weeks.
Does her baby need any blood tests after the delivery or during BF? if so, what needs to be checked?
Can the baby receive Hepatitis B vaccination at birth, or other vaccines during BF, or should she postpone the recommended timetable for vaccinations?
Thanx in advance, it's good to know we have a reliable comprehensive resource, because the doctors treating her RA, uveitis , pediatricians simply don't have any clue...

[admin]

osnatn:

The prednisone, 5mg/day is a very low dose, and poses no problem for a breastfeeding infant.

Humira (ADALIMUMAB) is a large molecular weight drug derived from IgG, which does not in reality even enter the milk compartment at clinically relevant levels. Adalimumab is a recombinant humanized IgG1 monoclonal antibody specific for human tumor necrosis factor (TNF). TNF is implicated in the pain and destructive component of arthritis and other autoimmune syndromes. This product would be similar to others such as etanercept (Enbrel) and infliximab (Remicade). IgG transfer into human milk is significant the first 4 days postpartum, then is minimal afterwards. The primary immunoglobulin in mature human milk is IgA.

Immunoglobulins are transferred into human milk by a very specific carrier protein which inhibits the transfer of IgG-like products. It is not known if these unusual immunoglobulins are transferred into milk, but it is unlikely.

Several other drugs similar to Humira have been studied and their levels in milk are exceedingly low and probably non-clinical. As for vaccinations, those done at birth are fine, as the infant has not been exposed to adalimumab. Those done afterward are probably just fine as well. The mom is the one who must worry about exposure to live viruses.

I'd suggest it is OK for her to breastfeed.

Tom Hale Ph.D.
InfantRisk Center

[osnatn]

to be sure we understand - do you recommend breastfeeding since birth or only after a week?
my sister is still taking humira during pregnancy, so baby is exposed to drug before birth. does drinking the colostrum raise blood levels of humira in baby?
sincerely, osnat and maya

[admin]

Osnatn:

I seriously doubt that levels of Humira in colostrum will be clinically relevant, but they will be exceedingly low in mature milk.

I would suggest the infant breastfeed from birth. Any present in milk would just be destroyed in the GI tract by proteases.

Tom Hale Ph.D.

[RAmommy]

osnatn, did your sister breast feed on Humira? Was their any effects on the baby, did you have to get any blood work on the baby?

Thanks,
Alissa