4 Questions About Discontinuing Biologic Treatment of IBD During Pregnancy

The management of inflammatory bowel disease (IBD) during pregnancy is challenging due to limited data on the long-term effects of intrauterine exposure to the new medications, so called biologics.

Results of a retrospective study showed no difference in child outcomes if mothers with IBD continue infliximab throughout the pregnancy or closer to the delivery date.

Gastroenterology Consultant caught up with Brindusa Truta, MAS, MD, an assistant professor of medicine at Johns Hopkins Medicine, about the research.

Gastroenterology Consultant: What prompted you to conduct this study?

Brindusa Truta: We know there are challenges to managing IBD during pregnancy. When a patient becomes pregnant, they may want to discontinue their biologic treatment to avoid potential side effects of intrauterine exposure to the drug. Infliximab, which is one of the first biologics to be used for the treatment of IBD, is actively transported across the placenta beginning around 20 weeks of gestation. When we performed quantitative measurements of infliximab levels, we noticed that the levels were significantly lower in the cord blood of newborns of pregnant women who discontinued infliximab treatment early during pregnancy. Discontinuation of therapy, however, can trigger disease flare and subsequently premature deliveries. Therefore, we wanted to compare pregnancy and child outcomes of patients with IBD who discontinued infliximab treatment early with those who discontinued infliximab treatment late during pregnancy.

GASTRO CON: Did any particular finding stand out to you?

BT: The study is one of the largest in the United States with data available on both outcomes of the mothers and their children. Based on the results, we can reassure physicians and their patients that there is no difference in pregnancy outcomes if mothers discontinue infliximab early or later during pregnancy. However, we noticed that early infliximab discontinuation is more likely to precipitate flare and requires more therapy.

GASTRO CON: What is the key takeaway of your study for a gastroenterologist?

BT: Until recently, the practice regarding therapy with biologics for these patients was to recommend they discontinue infliximab therapy before the third trimester, or at the beginning of the third trimester. With the risk of flare for the mother, we were concerned about the effect of infliximab on the baby. We have learned from this research that we should be able to continue infliximab throughout the pregnancy without expecting negative outcomes related to the high level of the medication in the newborn. Our data are reassuring and in accordance with data from other studies conducted in Europe that support the continuation of infliximab throughout the pregnancy without stopping treatment.

GASTRO CON: What are the next steps of your research?

BT: Going forward, we want to pursue looking at other biologics, such as adalimumab, to see if there is any difference in pregnancy outcomes. Adalimumab has a shorter half-life, which can likely influence the results of a singular study.

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Reference:

Brindusa T, Leeds I, Efron J, Canner JK, Safar B. Pregnancy outcomes in inflammatory bowel disease pregnancy treated with infliximab: early versus late discontinuation of therapy [abstract 43]. Presented at: Digestive Disease Week; May 18-21; San Diego, CA. https://www.gastrojournal.org/article/S0016-5085(19)36815-5/pdf. Accessed July 1, 2019.