From mother to baby: antenatal exposure to monoclonal antibody biologics. (4th March 2019)

• Record Type: Journal Article
• Authors: Pham-Huy, Anne; Sadarangani, Manish; Huang, Vivian; Ostensen, Monika; Castillo, Eliana; Troster, Sarah M.; Vaudry, Wendy; Nguyen, Geoffrey C.; Top, Karina A.
• Is Part Of: Expert review of clinical immunology. Volume 15:Number 3(2019)
• Page Start: 221
• Page End: 229
• Publication Date: 2019-03-04
• Subjects: Infant exposure -- pregnancy -- neonatal exposure -- infliximab -- adalimumab -- biologics -- monoclonal antibody -- rituximab in pregnancy -- tumor necrosis factor inhibitors -- ustekinumab; Clinical immunology -- Periodicals; 616.079
• DOI: 10.1080/1744666X.2019.1561282
• Languages: English
• ISSNs: 1744-666X

Abstract

ABSTRACT: Introduction : More women with autoimmune and inflammatory conditions are being treated with monoclonal antibody biologics (mAbs) during their pregnancy, to maintain clinical remission. The use of anti-tumor necrosis factor alpha agents in pregnancy appears to be safe but less is known regarding other mAbs, such as anti-integrins and anti-cytokine agents. There are currently no comprehensive guidelines on how to manage the exposed infants. Areas covered : We review recent literature to assess the impact of mAbs on birth and early infant outcomes, including what is currently known about maternal and infant drug levels at birth and drug clearance in the infant. We describe the potential risks of infections and reported hematological and immunological effects of antenatal mAbs exposure on the infant and provide guidance on the management of the exposed infant. Expert opinion : Exposed infants should be monitored closely. Certain mAb exposures require specific testing and management. Safety monitoring should be done in a multidisciplinary approach and should include pediatric care providers. The current clinical experience with anti-tumor necrosis factor agents in pregnancy cannot be extrapolated to other mAbs. Long-term observational studies and a multicenter international registry are needed to better appreciate the impact of exposure, especially to newer mAbs.