The use of anti-TNF drugs in pregnant inflammatory bowel diseas patients

Abstract

Upalna bolest crijeva je kronični upalni poremećaj koji se najčešće javlja u reproduktivnoj dobi u periodu od 15. do 30. godine života. Bolesnice se teže odlučuju na zasnivanje obitelji zbog straha od ishoda trudnoće, mogućih komplikacija zbog neželjenih utjecaja lijekova ili pojava komplikacije osnovne bolesti. Novija literatura o utjecaju bolesti i lijekova na trudnoću potvrđuje da je sigurnost trudnoće visoka, a posljedice djelovanja lijekova na plodnost, trudnoću i ishod trudnoće male. Tijek bolesti u trudnoći uvelike ovisi o aktivnosti bolesti u vrijeme začeća te se stoga savjetuje planirati trudnoću u remisiji bolesti. Potrebno je multidisciplinarno praćenje bolesnica kako bi se na vrijeme ukinuli lijekovi koji su kontraindicirani te kako bi se pažljivim praćenjem trudnoće spriječio nastanak mogućih komplikacija. Anti-TNF lijekovi za liječenje upalnih bolesti crijeva pripadaju u skupinu bioloških lijekova. Za njihovu primjenu karakteristična je visoka učinkovitost u postizanju remisije, značajan potencijal cijeljenja crijeva, ali i mogući razvoj važnih nuspojava. Kako su sve češće u primjeni, cilj ovog rada je prikaz dostupne literature o primjeni anti-TNF lijekova na plodnost, trudnoću i ishod trudnoće. Anti-TNF lijekovi smiju se primijeniti u trudnoći, ali s obzirom da se radi o monoklonskim protutijelima preporuča se u trećem trimestru trudnoće prekinuti liječenje jer postoji mogućnost placentarnog prijenosa. Kako je utjecaj anti-TNF molekula na imunosni sustav značajan, u dojenačkoj dobi, do šestog mjeseca života djeteta, ne preporuča se cijepljenje živim cjepivima.Inflammatory bowel disease is a chronic inflammatory disorder most commonly occurring in the reproductive age, in the period from 15 to 30 years of age. Female patients have a problem of family planning decision because of fear of pregnancy outcome, possible complications due to drug side-effects or complications of the underlying disease. Recent literature on the impact of diseases and drugs on pregnancy confirms that the most of drugs are safe and the effects of drugs on fertility and pregnancy outcome are positive. The course of illness during pregnancy largely depends on the disease activity at conception time and therefore is recommended to plan pregnancy in remission of the disease. Multidisciplinary monitoring of the patient is required in order to overcome the drugs that are contraindicated and to prevent possible complications during the pregnancy. Anti-TNF drugs for the treatment of inflammatory bowel diseases belong to a group of biological drugs. Anti-TNF drugs have high efficacy in achieving remission, significant potential for mucosal healing, as well as possible development of important side effects. As more and more commonly used last years, the aim of this study is to provide an overview of available anti-TNF drugs on fertility, pregnancy and pregnancy outcome. Anti-TNF drugs may be used during pregnancy, but regarding to the fact that there are monoclonal antibodies, it is recommended termination of therapy in the third trimester of pregnancy because of a possibility of placental transmission. As the effect of the anti-TNF molecule on the immune system is significant, at the infant age, up to the sixth month of the child's life, vaccination with live vaccines is not recommended