Early Discontinuation of Infliximab in Pregnant Women With Inflammatory Bowel Disease

• Published in: Inflammatory bowel diseases 2020-06, Vol.26 (7), p.1110-1117
• Main Authors: Truta, Brindusa, Leeds, Ira L, Canner, Joseph K, Efron, Jonathan E, Fang, Sandy H, Althumari, Azah, Safar, Bashar
• Format: Article
• Language: English
• Subjects: Birth defects; Comparative analysis; Development and progression; Disease susceptibility; Emergency medical services; Gastrointestinal diseases; Infants; Infliximab; Pregnancy; Pregnant women; Respiratory tract diseases
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1093/ibd/izz250

Abstract Objectives Early discontinuation of infliximab (IFX) in pregnant women with inflammatory bowel disease (IBD) decreases the intrauterine fetal exposure to the drug but may increase the risk of disease flaring leading to poor pregnancy outcomes. In this study, we assessed the impact of early IFX discontinuation on mother’s disease activity and on their at-risk babies. Methods In a retrospective study of the Truven Health Analytics MarketScan database from 2011 to 2015, we compared IBD patients who discontinued IFX more than 90 days (“early IFX”) with those who discontinue IFX 90 days or less (“late IFX) before delivery. We evaluated the risk of flaring, defined by new steroid prescriptions, visits to emergency room and/or hospital admissions, the pregnancy outcomes, and the at-risk babies. Results After IFX discontinuation, the early IFX group (68 deliveries) required significantly more steroid prescriptions than the late IFX group (318 deliveries) to control disease activity (P < 001). There were more preterm babies in the early IFX group (P < 049), but no difference within the 2 groups was noticed in the rate of intrauterine growth retardation, small for gestation, and stillborn babies. Similarly, there was no increase in acute respiratory infections, development delays, and congenital malformations in babies of the mothers from the late IFX vs early IFX groups. Conclusions Steroid-free remission IBD mothers are at risk for disease flares and preterm babies when IFX is discontinued early in pregnancy. Continuation of IFX seems to be safe at least for the first year of life. Management of inflammatory bowel disease (IBD) in pregnancy poses unique challenges due to limited data on the long-term effect of intrauterine exposure to biologics. In our study, we use a large administrative database to better characterize the risk of disease relapse if IFX is discontinued early in pregnancy, before starting crossing the placenta, and also the consequences of IFX discontinuation on the pregnancy and child outcomes. Video Abstract 10.1093/ibd/izz250_video1 Video Abstract izz250media1 6099892830001