A Woman with Rheumatoid Arthritis Who Successfully Delivered a Healthy Child with Continuous Administration of Sarilumab Throughout Pregnancy

Overview

Journal Intern Med

Specialty General Medicine

Date 2022 Jul 24

PMID 35871593

Authors

Satoshi Mizutani

Yuki Okunishi

Tatsuya Tamada

Hiroyuki Tanaka

Yuhei Ito

Yoshiki Yamamoto

Asa Kitamura

Hiroaki Tanaka

Tomoaki Ikeda

Ayako Nakajima

Affiliations

Soon will be listed here.

Abstract

We herein report a patient with rheumatoid arthritis (RA) who successfully delivered a healthy child with continuous administration of sarilumab throughout pregnancy. She delivered her first child, a healthy boy, following in vitro fertilization-embryo transfer (IVF-ET) while using etanercept and low-dose prednisolone. Disease activity persisted after delivery, so etanercept was switched to sarilumab. She became pregnant by IVF-ET again. Because RA was still active, sarilumab was continued during pregnancy. She delivered a healthy girl at the 38th week of gestation by Caesarean section. No abnormalities were detected at or within 6 months after birth. Sarilumab was safe and effective in this pregnant woman with RA.

References

Graham A, Rasmussen J, Rudolph M, Heim C, Gilmore J, Styner M . Maternal Systemic Interleukin-6 During Pregnancy Is Associated With Newborn Amygdala Phenotypes and Subsequent Behavior at 2 Years of Age. Biol Psychiatry. 2017; 83(2):109-119. PMC: 5723539. DOI: 10.1016/j.biopsych.2017.05.027. View

Mariette X, Forger F, Abraham B, Flynn A, Molto A, Flipo R . Lack of placental transfer of certolizumab pegol during pregnancy: results from CRIB, a prospective, postmarketing, pharmacokinetic study. Ann Rheum Dis. 2017; 77(2):228-233. PMC: 5867410. DOI: 10.1136/annrheumdis-2017-212196. View

Van de Perre P . Transfer of antibody via mother's milk. Vaccine. 2003; 21(24):3374-6. DOI: 10.1016/s0264-410x(03)00336-0. View

Nakajima K, Watanabe O, Mochizuki M, Nakasone A, Ishizuka N, Murashima A . Pregnancy outcomes after exposure to tocilizumab: A retrospective analysis of 61 patients in Japan. Mod Rheumatol. 2016; 26(5):667-71. PMC: 5020345. DOI: 10.3109/14397595.2016.1147405. View

Weber-Schoendorfer C, Chambers C, Wacker E, Beghin D, Bernard N, Shechtman S . Pregnancy outcome after methotrexate treatment for rheumatic disease prior to or during early pregnancy: a prospective multicenter cohort study. Arthritis Rheumatol. 2014; 66(5):1101-10. DOI: 10.1002/art.38368. View

Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C . The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016; 75(5):795-810. DOI: 10.1136/annrheumdis-2015-208840. View

Clowse M, Scheuerle A, Chambers C, Afzali A, Kimball A, Cush J . Pregnancy Outcomes After Exposure to Certolizumab Pegol: Updated Results From a Pharmacovigilance Safety Database. Arthritis Rheumatol. 2018; 70(9):1399-1407. PMC: 6174965. DOI: 10.1002/art.40508. View

Beltagy A, Aghamajidi A, Trespidi L, Ossola W, Meroni P . Biologics During Pregnancy and Breastfeeding Among Women With Rheumatic Diseases: Safety Clinical Evidence on the Road. Front Pharmacol. 2021; 12:621247. PMC: 8189556. DOI: 10.3389/fphar.2021.621247. View

de Man Y, Dolhain R, van de Geijn F, Willemsen S, Hazes J . Disease activity of rheumatoid arthritis during pregnancy: results from a nationwide prospective study. Arthritis Rheum. 2008; 59(9):1241-8. DOI: 10.1002/art.24003. View

10.

Spann M, Monk C, Scheinost D, Peterson B . Maternal Immune Activation During the Third Trimester Is Associated with Neonatal Functional Connectivity of the Salience Network and Fetal to Toddler Behavior. J Neurosci. 2018; 38(11):2877-2886. PMC: 5852665. DOI: 10.1523/JNEUROSCI.2272-17.2018. View

11.

de Steenwinkel F, Hokken-Koelega A, de Man Y, de Rijke Y, de Ridder M, Hazes J . Circulating maternal cytokines influence fetal growth in pregnant women with rheumatoid arthritis. Ann Rheum Dis. 2012; 72(12):1995-2001. DOI: 10.1136/annrheumdis-2012-202539. View

12.

Wakabayashi A, Sawada K, Nakayama M, Toda A, Kimoto A, Mabuchi S . Targeting interleukin-6 receptor inhibits preterm delivery induced by inflammation. Mol Hum Reprod. 2013; 19(11):718-26. DOI: 10.1093/molehr/gat057. View

13.

Cassina M, Johnson D, Robinson L, Braddock S, Xu R, Jimenez J . Pregnancy outcome in women exposed to leflunomide before or during pregnancy. Arthritis Rheum. 2012; 64(7):2085-94. DOI: 10.1002/art.34419. View

14.

Clowse M, Chakravarty E, Costenbader K, Chambers C, Michaud K . Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2012; 64(5):668-74. DOI: 10.1002/acr.21593. View

15.

Piccinni M, Lombardelli L, Logiodice F, Kullolli O, Parronchi P, Romagnani S . How pregnancy can affect autoimmune diseases progression?. Clin Mol Allergy. 2016; 14:11. PMC: 5025626. DOI: 10.1186/s12948-016-0048-x. View

16.

Velazquez-Salinas L, Verdugo-Rodriguez A, Rodriguez L, Borca M . The Role of Interleukin 6 During Viral Infections. Front Microbiol. 2019; 10:1057. PMC: 6524401. DOI: 10.3389/fmicb.2019.01057. View

17.

Eliesen G, van Drongelen J, Van Hove H, Kooijman N, Van Den Broek P, de Vries A . Assessment of Placental Disposition of Infliximab and Etanercept in Women With Autoimmune Diseases and in the Ex Vivo Perfused Placenta. Clin Pharmacol Ther. 2020; 108(1):99-106. PMC: 7325311. DOI: 10.1002/cpt.1827. View

18.

Hoeltzenbein M, Beck E, Rajwanshi R, Skorpen C, Berber E, Schaefer C . Tocilizumab use in pregnancy: Analysis of a global safety database including data from clinical trials and post-marketing data. Semin Arthritis Rheum. 2016; 46(2):238-245. DOI: 10.1016/j.semarthrit.2016.05.004. View