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RA medication and pregnancy

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  • RA medication and pregnancy

    Hello!
    My husband and I are considering getting pregnant again. Since my last pregnancy I have begun injection enbrel for RA and I realize that I cannot take this during pregnancy. My last pregnancy I took high doses of prednisolone. I would like to avoid using this drug at all if possible next time around.
    I am wondering which drugs I can use during pregnancy. Are there any biologic drugs that can be taken? I also take plaquenil and sulfursalazine and I know they are relatively safe however these two alone do are not enough for me to reduce flares.
    Any advice will be muchly appreciated.
    Thanks

  • #2
    Magda, thanks for posting,

    I have discussed this with Dr Hale and he advised that the use of Enbrel (etanercept) in pregnancy is a relatively low risk. Enbrel is rated a P2 in the new category ratings (category B in the old rating system). P2 is defined as: benefits are likely to exceed the risk. It appears that all of the biologic drugs listed on our data base are either P2 or P 3's.

    Enbrel (etanercept):There are no adequate and well-controlled studies in pregnant women. There have been several reports of normal pregnancy outcomes after etanercept exposure. Developmental toxicity studies have been performed in rats and rabbits at doses ranging from 60 to 100 fold higher than the human dose and have revealed no evidence of harm to the fetus due to etanercept. There are, however, no studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

    The greatest transfer of this drug is in the third trimester so most Dr's recommend trying to stop this medication during that time if possible, but this would need to be discussed on a individual basis with you Dr.

    The only other biologic medicine he might consider to have less transfer across the placenta is possibly Cimzia, but we do not know this for sure at this time, he is currently conducting a study on the Cimzia for pregnancy and breastfeeding, if you decide to switch to the Cimzia we would love for you to contact us so we could get you enrolled in the study. I hope this helps, if you have any other questions please contact the InfantRisk Center at 806-352-2519.

    Sandra Lovato R.N.
    InfantRisk Center

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    • #3
      Hello. I know I have already posted about this however I am now at the point where I need to decide whether I change my medication from Enbrel to Cimzia before I get pregnant. With such little information I am having trouble making up my mind. Are you able to give me any data about Cimzia during pregnancy? I realize that you are currently studying this so there are definite answers at the moment. I am trying to make an informed decision and this is proving to be difficult in my case. Any information other than what has already been given to me would be helpful at this point.
      Thanks

      Comment


      • #4
        Magda,

        Cimzia (certolizumab) is rated P2-benefits are likely to exceed the risk. This drug crosses the placenta in small amounts. Studies of infliximab, a similar drug, suggest that placental transfer of this drug class may be greatest in the third trimester. Animal studies in rats, using a murine analogue at doses above the recommended daily human dose, revealed no evidence of impaired fertility or toxicity to the fetus due to certolizumab. Animal studies are not always predictive of human response. Remember that 1-3% of all pregnancies can result in a birth defect due to chance alone. [COLOR=#333333][FONT=lucida grande]A single case study of a 22 year old woman treated with multiple monoclonal antibodies during pre-conception, as well as the first and third trimester, describe her pregnancy as producing a healthy child. The post-partum period was complicated by a retained placental fragment.

        Enbrel (etanercept) is rated a P2-benefits are likely to exceed the risk. There are no adequate and well-controlled studies in pregnant women. There have been several reports of normal pregnancy outcomes after etanercept exposure. Developmental toxicity studies have been performed in rats and rabbits at doses ranging from 60 to 100 fold higher than the human dose and have revealed no evidence of harm to the fetus due to etanercept. There are, however, no studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

        I hope this helps.

        Sandra Lovato R.N.
        InfantRisk Center
        806-352-2519[/FONT][/COLOR]

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