Immunosuppressives and biologics during pregnancy and lactation : Aconsensus report issued by the Austrian Societies of Gastroenterology and Hepatology and Rheumatology and Rehabilitation.

Antonia Puchner,Judith Sautner,Yvonne Helmy-Bader,Josef Hermann,Sieglinde Reinisch,Andrea Studnicka-Benke,Herbert Juch,Rudolf Puchner,Clemens Dejaco,Christoph Högenauer,Wolfgang Weger,Robert Koch,Hans Peter Gröchenig

doi:10.1007/s00508-019-1448-y

Abstract

SummaryAn increasing and early-onset use of immunosuppressives and biologics has become more frequently seen among patients with inflammatory bowel diseases (IBD) and rheumatic disorders. Many women in their childbearing years currently receive such medications, and some of them in an interdisciplinary setting. Many questions arise in women already pregnant or wishing to conceive with respect to continuing or discontinuing treatment, the risks borne by the newborns and their mothers and long-term safety. Together with the Austrian Society of Rheumatology and Rehabilitation, the IBD working group of the Austrian Society of Gastroenterology and Hepatology has elaborated consensus statements on the use of immunosuppressives and biologics in pregnancy and lactation. This is the first Austrian interdisciplinary consensus on this topic. It is intended to serve as a basis and support for providing advice to our patients and their treating physicians.

Highlights

The present consensus report issued by the Austrian Society of Gastroenterology and Hepatology (Österreichische Gesellschaft für Gastroenterologie und Hepatologie; ÖGGH) and the Austrian Society of Rheumatology and Rehabilitation (Österreichische Gesellschaft für Rheumatologie und Rehabilitation; ÖGR) is intended to provide practical guidelines for the application of immunosuppressives and biologics in pregnancy and the lactation period
Patients stably medicated with Cyclosporine A (CsA) or TAC should not switch and level measurements are recommended
Due to insufficient data and the long half-life of LEF, its application is not recommended in the lactation period [23, 38]

Summary

Introduction

The present consensus report issued by the Austrian Society of Gastroenterology and Hepatology (Österreichische Gesellschaft für Gastroenterologie und Hepatologie; ÖGGH) and the Austrian Society of Rheumatology and Rehabilitation (Österreichische Gesellschaft für Rheumatologie und Rehabilitation; ÖGR) is intended to provide practical guidelines for the application of immunosuppressives and biologics in pregnancy and the lactation period. The most recent investigation, a prospective cohort study with 309 IBD patients, showed no association between mothers’ thiopurine intake (35% of pregnancies) during gestation and increased risks of spontaneous abortion, “poor” birth results, or more frequent disorders among children within their first year of life [21].

Results

Conclusion