Update on safety during pregnancy of biological agents and some immunosuppressive anti-rheumatic drugs
Update on safety during pregnancy of biological agents and some immunosuppressive anti-rheumatic drugs
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DOI：
10.1093/rheumatology/ken168
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发表时间：
2008-06-01
期刊：
影响因子：
5.5
通讯作者：
Tincani, A.
中科院分区：
文献类型：
--
作者：
Ostensen, M.;Lockshin, M.;Tincani, A.
2006年发表了一份关于抗风湿药物与生殖相互作用的共识文件，其中包括2004年和2005年收集的数据。由于在育龄妇女中越来越多地使用生物制剂，2006年和2007年的信息更新了。专家们对tnf抑制剂是否应该在确认怀孕后立即停止或在整个怀孕期间继续使用持不同意见。阿巴接受和利妥昔单抗的妊娠经验仍然非常有限，无法证明它们对发育中的胎儿的安全性。它们必须在计划怀孕前停用。LEF尚未被证明是人类致畸物。移植受者的登记显示，环孢素（CsA）和他克莫司不会增加先天性异常的发生率，而霉酚酸酯（MMF）显然有先天性异常的风险。阿巴接受、利妥昔单抗、LEF和MMF在怀孕前必须预防性停药。关于免疫抑制药物对男性的性腺毒性以及这些药物在人类母乳中的排泄的数据仍然不足。
A consensus paper concerning the interaction of anti-rheumatic drugs and reproduction was published in 2006, representing data collected during the year 2004 and 2005. Because of an increasing use of biological agents in women of fertile age, the information was updated for the years 2006 and 2007. Experts disagree whether TNF-inhibitors should be stopped as soon as pregnancy is recognized or may be continued throughout pregnancy. Pregnancy experience with abatacept and rituximab is still too limited to prove their safety for the developing fetus. They must be withdrawn before a planned pregnancy. LEF has not been proven to be a human teratogen. Registries of transplant recipients have shown that cyclosporin ( CsA) and tacrolimus do not increase the rate of congenital anomalies, whereas mycophenolate mofetil ( MMF) clearly carries a risk for congenital anomalies. Prophylactic withdrawal of drugs before pregnancy is mandatory for abatacept, rituximab, LEF and MMF. Data remain insufficient for gonadal toxicity of immunosuppressive drugs in men and for excretion of these drugs in human breast milk.