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Safety issues of biologics in pregnant patients with rheumatic diseases

Authors

  • Monika Østensen

    Corresponding author
    1. National Service for Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, Trondheim, Norway
    • Address for correspondence: Professor Monika Østensen, National Service for Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Olav Kyrresgt 13, N-7006 Trondheim, Norway. monika.ostensen@gmail.com

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Abstract

The safety of biologic agents during pregnancy is still being investigated. Tumor necrosis factor α (TNF-α) inhibitors are the only well-studied biological drugs in pregnancy; they do not appear to be teratogenic but increase the risk of infection after birth when given in late pregnancy. The long-term effects in exposed children are, at present, unknown. An increased risk of infection is a concern for all biologics and the risk increases further should combination with glucocorticoids be necessary. Experiences with rituximab, abatacept, anakinra, tocilizumab, and belimumab in pregnancy are limited. These drugs should be avoided during pregnancy or used only when no other option is available for treatment of serious maternal disease.

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