#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Treatment of a pregnant Crohn’s disease patient with ustekinumab: a case report


Authors: Lukešová L. 1;  Nedbalová L. 1;  Šerclová Z. 2
Authors‘ workplace: Centrum pro bio­logickou léčbu nespecifických střevních zánětů, Gastroenterologie, Nemocnice Turnov, KN Liberec, a.  s. 1;  Chirurgické oddělení, Nemocnice Hořovice 2
Published in: Gastroent Hepatol 2019; 73(1): 43-45
Category: IBD: Case Report
doi: https://doi.org/10.14735/amgh201943

Overview

The balance between maintenance of remission and safety is important when treating idiopathic inflammatory bowel disease in pregnancy. Conception and pregnancy should be planned for the period of remission, and the therapeutic strategy leading to remission should be maintained during pregnancy and nursing. The drugs used to treat idiopathic bowel disease are relatively safe in pregnancy, except for methotrexate. A large amount of data indicate that anti-tumor necrosis factor α (TNFα) therapy in pregnancy is safe for both the mother and child. The risks of an increased infection rate, allergies, and immunodeficiencies in children of mothers who receive anti-TNFα therapy during pregnancy have not been confirmed. There is only limited experience of the use of ustekinumab in pregnancy. Although there are case reports of dermatology patients who received ustekinumab in pregnancy, the doses used in these patients are lower than those used to treat Crohn’s disease (CD). We report a CD patient who achieved clinical and laboratory remission and partial mucosal healing upon ustekinumab therapy. This effect was maintained by continuous therapy throughout pregnancy. The patient had a cesarean section at week 38 of gestation. Her daughter is healthy and continues to prosper.

Key words:

inflammatory bowel disease – anti-TNFα – infliximab – adalimumab – ustekinumab – gravidity – Crohn’s disease – biologic therapy

Submitted: 5. 2. 2019

Accepted: 10. 2. 2019

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for bio­­­­medical papers.


Sources

1. Vermeire S, Carbon­nel F, Coulie PG et al. Management of inflam­matory bowel dis­ease in preg­nancy. J Crohns Colitis 2012; 6(8): 811−823. doi: doi: 10.1016/j.crohns.2012.04.009.

2. van der Woude CJ, Ardizzone S, Bengtson MB et al. The second European evidencedbased consensus on reproduction and pregnancy in inflam­matory bowel dis­ease. J Crohns Colitis 2015; 9(2): 107−124. doi: 10.1093/ecco-jcc/jju006.

3. Damas OM, Deshpande AR, Avalos DJ et al. Treat­­ing inflam­matory bowel dis­ease in preg­nancy: the is­sues we face today. J Crohns Colitis 2015; 9(10): 928−936. doi: 10.1093/ ecco-jcc/jjv118.

4. Glover LE, Fen­nimore B, Wingfield M. In­flam­matory bowel dis­ease: influence and implications in reproduction. Inflamm Bowel Dis 2016; 22(11): 2724–2732. doi: 10.1097/ MIB.0000000000000884.

5. Bortlik M, Duricova D, Machkova N et al. Impact of anti-tumor necrosis factor alpha antibodies administered to pregnant women with inflam­matory bowel dis­ease on long-term outcome of exposed children. Inflamm Bowel Dis 2014; 20(3): 495–501. doi: 10.1097/01.MIB. 0000440984.86659.4f.

6. Mahadevan U, Martin CF, Sandler RS et al. PIANO: A 1000 patient prospective registry of pregnancy outcomes in women with IBD exposed to im­munomodulators and bio­logic ther­apy. Gastroenetol 2012: S149. [online]. Available from: https://www.gastrojournal.org/article/S0016-5085(12)60561-7/pdf.

7. SPC LP Stelara. [online]. Dostupné z: https://www.ema.europa.eu/documents/product-information/stelara-epar-product-information_cs.pdf.

8. Gal­luzzo M, D’Adamio S, Bianchi L. Psoriasis in pregnancy: case series and literature review of data concern­­ing exposure dur­­ing pregnancy to ustekinumab. J Dermatolog Treat 2018: 1–5. doi: 10.1080/09546634.2018.1468066.

9. Scherl E, Jacobstein D, Murphy C et al. A109 pregnancy outcomes in women exposedto ustekinumab in the Crohn’s dis­ease clin­ical development program. J Can Assoc Gastro­enterol 2018;1 (Suppl 2): 166. doi: 10.1093/jcag/gwy009.109.

10. Cortes X, Bor­rás-Blasco J, Antequera B et al. J Clin Pharm Ther 2017; 42(2): 234–236. doi: 10.1111/jcpt.12492.

11. Rowan CR, Cul­len G, Mulcahy HE et al. Ustekinumab drug levels in maternal and cord blood in a woman with Crohn‘s dis­ease treated until 33 weeks of gestation. J Crohns Colitis 2018; 12(3): 376–378. doi: 10.1093/ecco-jcc/jjx141.

12. Klenske E, Osaba L, Nagore D et al. Drug lev­els in the maternal serum, cord blood and breast milk of a ustekinumab-treated patient with Crohn‘s dis­ease. J Crohns Colitis 2019; 13(2): 267–269. doi: 10.1093/ecco-jcc/jjy153.

13. Matro R, Martin CF, Wolf D et al. Exposure concentrations of infants breastfed by women receiv­­ing bio­logic ther­apies for inflam­matory bowel dis­eases and ef­fects of breastfeed­­ing on infections and development. Gastroenterology 2018; 155(3): 696–704. doi: 10.1053/j.gastro.2018.05.040.

Labels
Paediatric gastroenterology Gastroenterology and hepatology Surgery
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#