P017 Planned infliximab use during pregnancy for pakistani patients with immune-mediated inflammatory disease - case series of 12 patients

Abstract

Abstract Background/Aims Immune-mediated inflammatory diseases (IMIDs) affect mostly young females during their reproductive age. Therefore, a better understanding is needed about the possible disease effects in pregnancy, as well as the risks of fetal exposure to the medications used. Studies have shown that anti-TNF are considered safe and do not increase the risk of adverse events during pregnancy. Nevertheless, the data is quite limited, hence fall in FDA pregnancy category B. We wish to report a series of 12 pregnant women with IMIDs who were intentionally being treated with infliximab for the treatment of active intractable IMIDs. Methods The study included pregnant patients with IMIDs who were treated using anti-TNF between January 2021 to July 2023 at Fatima Memorial Hospital and Doctors Hospital & Medical Centre, Lahore. All patients receiving infliximab were reviewed by a dedicated medical team, who maintained a detailed medical record of each visit. The patients were prospectively followed up and the neonatal outcome was also recorded. Results 12 pregnant women with IMIDs received Infliximab during this study. All these patients required >7.5mg of deltacortil to control their arthritis and hence decision was made to add bDMARDs. 10 patients successfully completed their pregnancies uneventfully and two additional patients are in the later stages of pregnancy. Seven patients had complete remission of their underlying IMIDs and the rest had overall good improvement but continued to have low grade active disease. All our patients presented a satisfactory response to treatment and the pregnancy progressed without any complications. Median gestational week of birth was 38 with a median birth weight of 3490 grams. Conclusion This is the first reported series from Pakistan of intentional infliximab use throughout pregnancy. Our data, combined with many other studies, suggests that anti-TNF is safe during pregnancy and its benefits in achieving control of IMIDs may outweigh the risk of foetal exposure to the drug. This is further supported by the available data suggesting the inflammatory activity as the main risk factor for unfavourable outcome. However, the benefits and risks must be discussed with the patient and management decisions should be taken on individual basis. Disclosure Z. Tayyab: None. M. Haroon: None.