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Efficacy and safety of certolizumab pegol in pregnant women with uveitis. Recommendations on the management with immunosuppressive and biologic therapies in uveitis during pregnancy

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23

 

  1. Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
  2. Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
  3. Clinic Institute of Ophthalmology (ICOF), Hospital Clinic of Barcelona, Spain.
  4. Clinic Institute of Ophthalmology (ICOF), Hospital Clinic of Barcelona, Spain.
  5. Rheumatology, Hospital Universitario de Donostia, San Sebastián, Spain.
  6. Rheumatology, Hospital Universitario Txagorritxu, Vitoria-Gasteiz, Spain.
  7. Rheumatology, Hospital de Mérida, Spain.
  8. Internal Medicine, Hospital Galdakano, Vizcaya, Spain.
  9. Rheumatology, Hospital Universitario Río Hortega, Valladolid, Spain.
  10. Rheumatology, Hospital General Universitario de Elche, Alicante, Spain.
  11. Rheumatology, Hospital Universitario de Badajoz, Spain.
  12. Rheumatology, Hospital de Cabueñes, Gijón, Spain.
  13. Rheumatology, Hospital General Universitari de Castelló, Castellón de la Plana, Spain.
  14. Rheumatology, Hospital Río Carrión, Palencia, Spain.
  15. Ophthalmology, Complejo Asistencial Universitario de León, Spain.
  16. Ophthalmology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
  17. Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
  18. Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
  19. Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, and University of Cantabria, School of Medicine, Santander, Spain.
  20. Rheumatology, Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain.
  21. Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
  22. Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, University of Cantabria, School of Medicine, Santander, Spain, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. miguelaggay@hotmail.com
  23. Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain. rblanco@humv.es

CER13083
2021 Vol.39, N°1
PI 0105, PF 0114
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PMID: 33124565 [PubMed]

Received: 07/01/2020
Accepted : 16/03/2020
In Press: 09/10/2020
Published: 05/02/2021

Abstract

OBJECTIVES:
Clinicians often face the challenge of providing effective and safe therapy for pregnant women with uveitis. Certolizumab pegol (CZP) differs from other anti-TNFα agents due to its limited placental transfer. In this study we assessed the efficacy of CZP in pregnant women with uveitis. We also provided information on outcomes of pregnant women and neonates exposed to CZP.
METHODS:
We carried out a multicentre study of women with uveitis who received CZP during pregnancy and their neonates. The main visual outcomes were visual acuity (VA), intraocular inflammation and corticosteroid-sparing effect. Pregnancy outcomes, maternal and neonatal infections and congenital malformations were also assessed.
RESULTS:
We studied 14 women (23 affected eyes); mean age of 34.3±5.5 years. The underlying diseases were spondyloarthritis (n=7), idiopathic (n=2), and Vogt-Koyanagi-Harada, rheumatoid arthritis, juvenile idiopathic arthritis, punctate inner choroidopathy and Behçet’s disease (1 each). The patterns of ocular involvement were anterior (n=10), posterior (n=2), intermediate (n=1), panuveitis (n=1). Cystoid macular oedema was present in one patient (1 eye). Uveitis was bilateral in nine cases and chronic in seven patients. CZP was started before getting pregnant in ten patients and after conceiving in four. All patients achieved or maintained ocular remission throughout pregnancy. Fifteen healthy infants were born. Only one woman presented a mild infection during pregnancy. Neither infections nor malformations were observed in neonates after a follow-up of 6 months. Six infants were breastfed and all of them received scheduled vaccinations without complications.
CONCLUSIONS:
Certolizumab pegol is effective and safe in women with uveitis during pregnancy.

DOI: https://doi.org/10.55563/clinexprheumatol/j9ysbm

Rheumatology Article