SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Vered ABITBOL-SELINGER
Coup de coeur :
 
 
The American Journal of Gastroenterology
  2018/11  
 
  2018 Nov;113(11):1669-1677.  
  doi: 10.1038/s41395-018-0176-7.  
 
  Continuous Anti-TNFα Use Throughout Pregnancy: Possible Complications For the Mother But Not for the Fetus. A Retrospective Cohort on the French National Health Insurance Database (EVASION)  
 
  Luu M, Benzenine E, Doret M, Michiels C, Barkun A, Degand T, Quantin C, Bardou M  
  https://www.ncbi.nlm.nih.gov/pubmed/29961771  
 
 

Abstract

OBJECTIVES:

Inflammatory bowel diseases (IBD) need long-term treatment, which can influence pregnancies in young women. Uncontrolled IBD is associated with poor pregnancy outcomes. Despite the labeling of Anti-tumor necrosis factor (TNF) antibodies (anti-TNFα) which indicates that their use is not recommended during pregnancy, anti-TNFα are increasingly being used during pregnancy and may expose women and their fetuses to treatment-related complications. Existing recommendations on the timing of treatment during pregnancy are inconsistent. We aimed to assess the safety of anti-TNFα treatment in pregnant women with IBD, and up to the first year of life for their children.

METHODS:

An exposed/non exposed retrospective cohort was conducted on the French national health system database SNIIRAM (Système National d'Information Inter-Régimes de l'Assurance Maladie). All IBD women who became pregnant between 2011 and 2014 were included. Women with concomitant diseases potentially treated with anti-TNFα were excluded. Anti-TNFα exposure (infliximab, adalimumab, golimumab or certolizumab pegol) during pregnancy was retrieved from the exhaustive prescription database in SNIIRAM. The main judgment criterion was a composite outcome of disease-, treatment- and pregnancy-related complications during pregnancy for the mother, and infections during the first year of life for children.

RESULTS:

We analyzed data from 11,275 pregnancies (8726 women with IBD), among which 1457 (12.9%) pregnancies were exposed to anti-TNFα, mainly infliximab or adalimumab, with 1313/7722 (17.0%) suffering from Crohn's disease and 144/3553 (4.1%) from ulcerative colitis. After adjusting for disease severity, steroid use, age, IBD type, and duration and concomitant 6-mercaptopurine use, anti-TNFα treatment was associated with a higher risk of overall maternal complications (adjusted Odds Ratio (aOR) = 1.49; 95% confidence interval (CI): 1.31-1.67) and infections (aOR = 1.31; 95% CI: 1.16-1.47). Maintaining anti-TNFα after 24 weeks did not increase the risk of maternal complication, but interrupting the anti-TNFα increased relapse risk. No increased risk for infection was found in children (aOR = 0.89; 95% CI: 0.76-1.05) born to mother exposed to anti-TNFα during pregnancy.

CONCLUSIONS:

Anti-TNFα treatment during pregnancy increased the risk of maternal complications compared to unexposed; however, discontinuation before week 24 increased the risk of disease flare. There was no increased risk for children exposed to anti-TNFα up to 1 year of life.

 

 
Question posée
 
Le maintien d’un traitement par anti-TNF durant la grossesse est-il associé à des complications chez les femmes atteintes de MICI ou chez leur enfant pendant la première année de vie?
 
Question posée
 
• Oui le maintien de l’anti-TNF pendant la grossesse est associé à une augmentation de complications chez la mère en particulier infectieuses • Non le maintien de l’anti-TNF n’est pas associé à des complications chez l’enfant exposé in utero • L’arrêt de l’anti-TNF avant la 24e semaine est associé à un risque de poussée de la MICI • Le maintien de l’anti-TNF au-delà de la 24e semaine n’est pas associé à une augmentation des complications
 
Commentaires

Cette large étude rétrospective française basée sur les données de la SNIIRAM suggère que lorsque l’anti-TNF est indiqué pendant la grossesse, il peut être maintenu au-delà de la 24e semaine sans augmentation de la morbidité.

 
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