TOPLINE:

A review found that TNF inhibitor exposure during pregnancy or breastfeeding was not associated with an increase in severe infant infections or impaired responses to routine vaccines.

METHODOLOGY:

• Researchers conducted a review to assess infection rates and vaccination safety outcomes in infants exposed to TNF inhibitors in utero or via breastfeeding used to treat women with various autoinflammatory diseases, including but not limited to psoriasis, psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, and Crohn’s disease.
• The analysis included 10 retrospective studies, prospective studies, and systematic reviews published until June 2024, which reported infection rates and vaccination outcomes in infants exposed to TNF inhibitors (certolizumab pegol, adalimumab, infliximab, etanercept, and golimumab) in utero or through breastfeeding.

TAKEAWAY:

• Gestational exposure to TNF inhibitors was not associated with an increased risk for severe infections in infants (four studies), with similar findings observed for infants exposed through breast milk (two studies).
• Vaccination outcomes, including efficacy and adverse events, were comparable between exposed and unexposed infants.
• Severe vaccine-related events were rare, although one death after BCG vaccination was reported in an infant with in utero TNF inhibitor exposure, for which the study authors recommended “delaying the vaccination or measuring the anti-TNF blood level before vaccine administration.”

IN PRACTICE:

“By demonstrating a positive safety profile through various cohort studies, the research supports the potential for broader use” of TNF inhibitor treatment “in pregnant populations when the severity of the maternal disease warrants systemic therapy,” the study authors wrote. “Dermatologists,” they added, “should still ensure detailed consultation with the patient, which describes the potential risks and benefits” of TNF inhibitor treatment during pregnancy.

SOURCE:

The study was led by Marita Yaghi, MD, Department of Dermatology, Larkin Community Hospital, South Miami, Florida, and was published online in the International Journal of Women’s Dermatology.

LIMITATIONS:

The absence of randomized controlled trials could affect the robustness of the conclusions.

DISCLOSURES:

The study did not receive any funding. Yaghi reported receiving research support from the Hidradenitis Suppurativa Foundation. Another author disclosed being on the speakers board for Galderma, UCB, and Sanofi-Regeneron; serving on advisory boards for UCB, Galderma, Arcutis Biotherapeutics, Sanofi-Regeneron, and Bristol Myers Squibb; and providing dermatologic consulting services for UCB, AbbVie, Sanofi-Regeneron, and UpToDate.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.