Cargando…

Analysing cord blood levels of TNF inhibitors to validate the EULAR points to consider for TNF inhibitor use during pregnancy

BACKGROUND: To minimise placental transfer of tumour necrosis factor inhibitors (TNFi), the European League Against Rheumatism (EULAR) created points to consider (PtC) for the use of TNFi during pregnancy. We are the first to validate the EULAR-PtC by analysing TNFi concentrations in cord blood. MET...

Descripción completa

Detalles Bibliográficos
Autores principales: Ghalandari, Nafise, Kemper, Erik, Crijns, Ineke (Hubertina), Wolbink, Gertjan, Rispens, Theo, Smeele, Hieronymus TW, Dolhain, Radboud JEM
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8862049/
https://www.ncbi.nlm.nih.gov/pubmed/34493490
http://dx.doi.org/10.1136/annrheumdis-2021-221036
_version_ 1784654987142365184
author Ghalandari, Nafise
Kemper, Erik
Crijns, Ineke (Hubertina)
Wolbink, Gertjan
Rispens, Theo
Smeele, Hieronymus TW
Dolhain, Radboud JEM
author_facet Ghalandari, Nafise
Kemper, Erik
Crijns, Ineke (Hubertina)
Wolbink, Gertjan
Rispens, Theo
Smeele, Hieronymus TW
Dolhain, Radboud JEM
author_sort Ghalandari, Nafise
collection PubMed
description BACKGROUND: To minimise placental transfer of tumour necrosis factor inhibitors (TNFi), the European League Against Rheumatism (EULAR) created points to consider (PtC) for the use of TNFi during pregnancy. We are the first to validate the EULAR-PtC by analysing TNFi concentrations in cord blood. METHODS: Patients were derived from the Preconceptional Counselling in Active Rheumatoid Arthritis Study. TNFi was stopped at the time points recommended by the EULAR. Maternal blood and cord blood were collected and analysed for the concentration of TNFi. RESULTS: 111 patients were eligible for the analysis. Median stop time points were gestational age (GA) 37.0 weeks for certolizumab pegol, GA 25.0 weeks for etanercept, GA 19.0 weeks for adalimumab and GA 18.4 weeks for infliximab. Certolizumab pegol (n=68) was detectable in 5.9% of cord blood samples, with a median concentration of 0.3 µg/mL (IQR: 0.2–1.3) and a median cord/maternal concentration ratio of 0.010. Etanercept (n=30) was not detected in any cord blood samples. Adalimumab (n=25) was detectable in 48.0% of cord blood samples, with a median concentration of 0.5 µg/mL (IQR: 0.2–0.7) and a median concentration ratio of 0.062 (IQR: 0.018–0.15). Infliximab (n=14) was detectable in 57.1% of cord blood samples, with a median concentration of 0.4 µg/mL (IQR: 0.1–1.2) and a median concentration ratio of 0.012 (IQR: 0.006–0.081). CONCLUSION: Compliance with the EULAR-PtC results in absence or low levels of TNFi in cord blood.
format Online
Article
Text
id pubmed-8862049
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-88620492022-03-15 Analysing cord blood levels of TNF inhibitors to validate the EULAR points to consider for TNF inhibitor use during pregnancy Ghalandari, Nafise Kemper, Erik Crijns, Ineke (Hubertina) Wolbink, Gertjan Rispens, Theo Smeele, Hieronymus TW Dolhain, Radboud JEM Ann Rheum Dis Treatment BACKGROUND: To minimise placental transfer of tumour necrosis factor inhibitors (TNFi), the European League Against Rheumatism (EULAR) created points to consider (PtC) for the use of TNFi during pregnancy. We are the first to validate the EULAR-PtC by analysing TNFi concentrations in cord blood. METHODS: Patients were derived from the Preconceptional Counselling in Active Rheumatoid Arthritis Study. TNFi was stopped at the time points recommended by the EULAR. Maternal blood and cord blood were collected and analysed for the concentration of TNFi. RESULTS: 111 patients were eligible for the analysis. Median stop time points were gestational age (GA) 37.0 weeks for certolizumab pegol, GA 25.0 weeks for etanercept, GA 19.0 weeks for adalimumab and GA 18.4 weeks for infliximab. Certolizumab pegol (n=68) was detectable in 5.9% of cord blood samples, with a median concentration of 0.3 µg/mL (IQR: 0.2–1.3) and a median cord/maternal concentration ratio of 0.010. Etanercept (n=30) was not detected in any cord blood samples. Adalimumab (n=25) was detectable in 48.0% of cord blood samples, with a median concentration of 0.5 µg/mL (IQR: 0.2–0.7) and a median concentration ratio of 0.062 (IQR: 0.018–0.15). Infliximab (n=14) was detectable in 57.1% of cord blood samples, with a median concentration of 0.4 µg/mL (IQR: 0.1–1.2) and a median concentration ratio of 0.012 (IQR: 0.006–0.081). CONCLUSION: Compliance with the EULAR-PtC results in absence or low levels of TNFi in cord blood. BMJ Publishing Group 2022-03 2021-09-07 /pmc/articles/PMC8862049/ /pubmed/34493490 http://dx.doi.org/10.1136/annrheumdis-2021-221036 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Treatment
Ghalandari, Nafise
Kemper, Erik
Crijns, Ineke (Hubertina)
Wolbink, Gertjan
Rispens, Theo
Smeele, Hieronymus TW
Dolhain, Radboud JEM
Analysing cord blood levels of TNF inhibitors to validate the EULAR points to consider for TNF inhibitor use during pregnancy
title Analysing cord blood levels of TNF inhibitors to validate the EULAR points to consider for TNF inhibitor use during pregnancy
title_full Analysing cord blood levels of TNF inhibitors to validate the EULAR points to consider for TNF inhibitor use during pregnancy
title_fullStr Analysing cord blood levels of TNF inhibitors to validate the EULAR points to consider for TNF inhibitor use during pregnancy
title_full_unstemmed Analysing cord blood levels of TNF inhibitors to validate the EULAR points to consider for TNF inhibitor use during pregnancy
title_short Analysing cord blood levels of TNF inhibitors to validate the EULAR points to consider for TNF inhibitor use during pregnancy
title_sort analysing cord blood levels of tnf inhibitors to validate the eular points to consider for tnf inhibitor use during pregnancy
topic Treatment
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8862049/
https://www.ncbi.nlm.nih.gov/pubmed/34493490
http://dx.doi.org/10.1136/annrheumdis-2021-221036
work_keys_str_mv AT ghalandarinafise analysingcordbloodlevelsoftnfinhibitorstovalidatetheeularpointstoconsiderfortnfinhibitoruseduringpregnancy
AT kempererik analysingcordbloodlevelsoftnfinhibitorstovalidatetheeularpointstoconsiderfortnfinhibitoruseduringpregnancy
AT crijnsinekehubertina analysingcordbloodlevelsoftnfinhibitorstovalidatetheeularpointstoconsiderfortnfinhibitoruseduringpregnancy
AT wolbinkgertjan analysingcordbloodlevelsoftnfinhibitorstovalidatetheeularpointstoconsiderfortnfinhibitoruseduringpregnancy
AT rispenstheo analysingcordbloodlevelsoftnfinhibitorstovalidatetheeularpointstoconsiderfortnfinhibitoruseduringpregnancy
AT smeelehieronymustw analysingcordbloodlevelsoftnfinhibitorstovalidatetheeularpointstoconsiderfortnfinhibitoruseduringpregnancy
AT dolhainradboudjem analysingcordbloodlevelsoftnfinhibitorstovalidatetheeularpointstoconsiderfortnfinhibitoruseduringpregnancy