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Thiopurines, anti-TNF-a drugs safe for pregnant women with IBD
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Pregnant women with IBD treated with thiopurines and anti-tumor necrosis factor-alpha drugs were not at increased risk for complications during pregnancy in a recent study.
In a multicenter, retrospective cohort study, researchers evaluated women with IBD who had been exposed to thiopurines (group A; n=187), anti-tumor necrosis factor-alpha (anti-TNF-a) drugs with or without thiopurines (group B; n=66) or neither (n=318) during pregnancy or within 3 months of conception. Obstetric complications in mothers and infants were considered unfavorable global pregnancy outcomes (GPOs).
Live births occurred in 498 of 571 pregnancies, including 253 in groups A and B and 318 among nonexposed participants. Unfavorable GPOs occurred more frequently in group B (34.8%) than the nonexposed group (31.8%) or those exposed to thiopurines (21.9%) (P=.01 for difference between thiopurines and nonexposed). Similarly, neonatal complications occurred less frequently among those exposed to thiopurines (13.9%) than nonexposed participants (23.3%) or group B (21.2%) (P=.03). Pregnancy complications were similar (20.9% in group A, 30.3% in group B and 27.7% among nonexposed).
Patients who stopped anti-TNF-a drugs within the first trimester had more unfavorable GPOs than those who maintained treatment throughout pregnancy (69% unfavorable GPOs compared with 25%, P<.05), including a higher rate of spontaneous abortion (46% vs. 0%, P=.001).
Multivariate analysis indicated an association between favorable GPO and thiopurine treatment (OR=0.6, 0.4-0.9), while age older than 35 years at conception was associated with a negative outcome (OR=1.67, 1.03-2.7) (95% CI for both). No association was observed between unfavorable GPO and anti-TNF-a drugs with or without thiopurines.
“The results of this study suggest that the use of thiopurines and anti-TNF-a drugs during conception and pregnancy is safe for the mother and the newborn,” the researchers concluded. “These findings increase the growing evidence of the safety of these drugs during pregnancy, which, added to the importance of the maintenance of remission during this period, suggest that these treatments should not be discontinued in pregnant woman [or] in those who wish conception.”
Disclosure: See the study for a full list of relevant disclosures.
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