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    Home > Active Ingredient News > Digestive System Information > ​[Mother's Day Special Issue] Caring for mothers and paying attention to the treatment of women with Crohn's disease

    ​[Mother's Day Special Issue] Caring for mothers and paying attention to the treatment of women with Crohn's disease

    • Last Update: 2021-05-22
    • Source: Internet
    • Author: User
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    Only for medical professionals to read.
    Can CD patients become pregnant? Do I need to stop the drug during pregnancy? Can I breastfeed while undergoing treatment? The age of onset of Crohn's disease (CD) is mainly concentrated in the 18-35 years old, this is the age of youth blooming, full of hope and yearning for life and life.

    Getting married and working with children, these beautiful hopes for the future may be overshadowed by illness.

    Many female CD patients are not only suffering from physical pain, but also facing difficulties in life, especially for expectant mothers and breastfeeding mothers during pregnancy and pregnancy.
    Their own diseases and the health of their babies have become important concerns for them.
    problem.

    Caring for CD mothers and paying attention to the treatment of female CD patients, let us walk into their stories and doubts and discuss their CD biologics treatment together.

     Expectant mother-Huihui: I am 29 years old and I was diagnosed with CD a few years ago.
    I just got married last year.

    I really hope to have a lovely baby, but I am worried about whether my physical condition will be able to get pregnant, and whether it will affect the health of the baby.
    Can I get pregnant? Questions and answers research shows that 83% of CD patients have a normal pregnancy, and the incidence of abnormalities, spontaneous abortion and stillbirth are the same as those of healthy people[1], so expectant mothers can relax and do not have to be excessive due to their own illness.
    anxiety.

    At the same time, my country’s "Expert Consensus on the Management of Inflammatory Bowel Disease during Pregnancy" pointed out that the fertility and pregnancy outcome of patients in remission of CD are comparable to those of the general population, and patients who reach the remission period can obtain better pregnancy outcomes[2] .

    Therefore, expectant mothers also need to fully evaluate their condition, and try their best to start normal pregnancy after proper treatment before pregnancy to achieve relief of the disease.

    In addition, in the process of disease management before pregnancy in CD patients, the medication needs to pay attention to the efficacy and safety at the same time.

    Anti-TNFα monoclonal antibody is the first-line treatment of moderate to severe CD that is unanimously recommended by authoritative guidelines [2-3].

    Among them, the original research adalimumab can quickly and significantly improve inflammation within 1 week [4], and maintain a clinical remission rate of 75% for 6 years [5].
    It is a first-line biological agent unanimously recommended by domestic and foreign guidelines, which can help patients in pregnancy To achieve clinical remission in advance to improve pregnancy outcome [3-6].

    As the world’s first fully human anti-TNFα monoclonal antibody on the market for many years, it has low immunogenicity and good tolerability[7].
    It has a large amount of real-world experience and data and 12 years of safety data guarantee[8] , Pregnant mothers can rest assured to receive treatment.

    However, it is worth noting that infliximab is another anti-TNFα monoclonal antibody marketed in my country.
    As a human-mouse chimeric monoclonal antibody, the incidence of anti-antibodies is relatively high.
    The instructions clearly indicate that it is not recommended for use during pregnancy and lactation [ 9].

    In addition, other domestic biological agents newly approved for the treatment of moderate to severe CD, such as veldrizumab and usnulumab, have a short time to market and lack relevant evidence.
    It is prudent to avoid using them as much as possible[10,11] .

    Pregnant expectant mother-Xiao Zhang: Hello! I am 32 years old and found out last week that I have been pregnant for 7 weeks.
    I am looking forward to this little life.

    But I am a CD patient and have been undergoing maintenance treatment.
    I am afraid that the treatment drugs will have adverse effects on the fetus.
    Do I need to stop the medication? Questions and answers Regarding the safety of the treatment of patients with CD during pregnancy, my country’s "Expert Consensus Opinions on the Management of Inflammatory Bowel Disease during Pregnancy" pointed out that moderate to severe activity occurs during maintenance treatment with sufficient 5-ASA or thiopurine drugs.
    Systemic glucocorticoids or anti-TNFα monoclonal antibodies should be considered to induce remission; IBD patients with moderate to severe activity during pregnancy and glucocorticoid resistance are recommended to use anti-TNFα monoclonal antibodies to induce remission; activities during pregnancy are treated with glucocorticoids After induction of remission, for patients whose 5-ASA cannot maintain remission, it is not recommended to use thiopurine drugs for the first time during pregnancy.
    Anti-TNFα monoclonal antibody may be considered to maintain remission.
    After anti-TNFα monoclonal antibody induces remission, it is recommended to continue the drug for maintenance treatment .

    At the same time, for patients who use anti-TNFα monoclonal antibody to maintain remission, the drug can continue to be treated during pregnancy [2].

    Currently approved anti-TNFα monoclonal antibodies in my country include infliximab and original research adalimumab.

    As a human-mouse chimeric monoclonal antibody, infliximab is highly immunogenic, and its risk during pregnancy cannot be ruled out, so its use during pregnancy is not recommended [9].

    The original research adalimumab, as a fully human monoclonal antibody, has low immunogenicity and good tolerability.
    Its instructions clearly state that pregnant patients can receive treatment when they clearly need it.

    In addition, the 2016 Toronto consensus pointed out that the last time the original research adalimumab was used was between the 34th and 36th weeks of pregnancy, and then resumed treatment after delivery [10].

    Finally, at present, the newly approved domestic veldrizumab and usnuzumab for the treatment of moderate to severe CD have a short time to market, and the research data in special populations during pregnancy is not sufficient, and their use should be avoided as much as possible [11,12 ].

    The medication risks of each biological agent are shown in Table 1.

    Nursing mother-Xiaoyi: I am a CD patient.
    I just passed my 35th birthday last month and welcomed my baby.
    Every time I see him sleeping soundly in my arms, I feel very happy.

    But I still have a concern.
    Can breastfeeding be carried out at the same time as treatment? Answers and puzzles Anti-TNFα monoclonal antibody is the first-line treatment for inducing and maintaining remission of moderate to severe CD that is unanimously recommended by authoritative guidelines of Chinese and foreign guidelines.
    It has the longest time to market and the most widely used.

    The consensus opinion of experts pointed out that the concentration of the original research adalimumab in human milk is 0.
    1% to 1% of the maternal serum level, and this part of the anti-TNFα monoclonal antibody will also undergo protein hydrolysis in the gastrointestinal after ingestion.
    The utilization rate is poor, and it is expected that it will not affect breastfeeding newborns/infants [2,7].

    The original research adalimumab, as a fully human monoclonal antibody, has lower immunogenicity and good tolerability.
    The instructions clearly indicate that breastfeeding patients can be used normally [7], so breastfeeding mothers can safely receive treatment.

    However, it is not clear whether the human-mouse chimeric monoclonal antibody infliximab is secreted from milk and whether it will be absorbed after breastfeeding.
    Therefore, the instructions recommend that breastfeeding patients should stop breastfeeding for at least 6 months after receiving infliximab treatment.
    .

    For Uselnuzumab and vedelizumab, due to the current lack of relevant research data, it is prudent to avoid the use of breastfeeding patients [2,11,12].

    The medication risks of each biological agent are shown in Table 1.

    Table 1 The risks of medications commonly used in patients with inflammatory bowel disease during pregnancy and lactation [2,7,9-11,12] References: 1.
    Miller JP.
    JR Soc Med.
    1986 Apr;79(4):221 -5.
    2.
    Inflammatory Bowel Disease Group of Digestive Disease Branch of Chinese Medical Association.
    Peking Union Medical College Journal.
    2016;10(5):465–75.
    3.
    Torres J, Bonovas S, Doherty G, Kucharzik T, Gisbert JP, Raine T, et al.
    J Crohn's Colitis.
    2020;14(1):4–22.
    4.
    Hanauer SB, et al.
    Gastroenterology.
    2006 Feb;130(2):323-33.
    5.
    Loftus EV et al.
    Inflamm Bowel Dis.
    2019;25 (9):1522-31.
    6.
    Inflammatory Bowel Disease Group, Chinese Society of Digestive Diseases.
    Chinese Journal of Inflammatory Bowel Disease.
    2017;1(3):150-4.
    7.
    Adalimumab Chinese Instruction.
    2019.
    8.
    Burmester GR, et al.
    Adv Ther.
    2020 Jan;37(1):364-380.
    9.
    Infliximab Chinese Manual.
    10.
    Nguyen GC, et al.
    Gastroenterology.
    2016 Mar;150(3):734-757.
    e1 11.
    Instructions for Verdrizumab in China.
    December 2020.
    Instructions for Uselizumab in China.
    2019.
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