ARD: Analysis of cord blood levels of TNF inhibitors to validate EULAR recommendations for TNF inhibitor use during pregnancy

Background: Tumor necrosis factor inhibitors (TNFi) can be actively transported across the placentaas early as the 20th week of pregnancy, mediated by fetal Fc receptors and dependent on the structure of TNFi .
Based on limited evidence, the European League of Rheumatology Associations (EULAR) recommends discontinuation of adalimumab and infliximab at 20 weeks of gestational age and etanercept at 30-32 weeks of gestational age, and conditional continue to use certolizumab polyethylene glycol .
Current data only demonstrate that umbilical cord blood concentrations are maintained at minimal levels when certolizumab-pegylated treatment is continued throughout pregnancy .
This study validated the reliability of EULAR 's recommendations by analyzing TNFi concentrations in cord blood .

Background: Tumor necrosis factor inhibitors (TNFi) can be actively transported across the placentaas early as the 20th week of pregnancy, mediated by fetal Fc receptors and dependent on the structure of TNFi .

Based on limited evidence, the European League of Rheumatology Associations (EULAR) recommends discontinuation of adalimumab and infliximab at 20 weeks of gestational age and etanercept at 30-32 weeks of gestational age, and conditional continue to use certolizumab polyethylene glycol .
Current data only demonstrate that umbilical cord blood concentrations are maintained at minimal levels when certolizumab-pegylated treatment is continued throughout pregnancy .
This study validated the reliability of EULAR 's recommendations by analyzing TNFi concentrations in cord blood .

Methods: Patients were from preconception counseling in the Active Rheumatoid Arthritis Study
.

Stop TNFi at the EULAR -recommended time points .
Maternal and cord blood were collected and analyzed for TNFi concentrations .

Methods: Patients were from preconception counseling in the Active Rheumatoid Arthritis Study

Results: 111 patients were eligible for analysis

    CONCLUSIONS: Following EULAR recommendations resulted in the absence or maintenance of low levels of TNFi in cord blood , suggesting that the infant's immune system may not be affected

 

    Source: Ghalandari N, Kemper E, Crijns I( , et al .

Analysing cord blood levels of TNF inhibitors to validate the EULAR points to consider for TNF inhibitor use during pregnancy.
Annals of the Rheumatic Diseases  2022; 81: 402-405.

    Source: Ghalandari N, Kemper E, Crijns I( , et al .

 

 

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