ARD:分析TNF抑制剂的脐带血水平以验证EULAR在怀孕期间使用TNF抑制剂的建议

2022-03-26 MedSci原创 MedSci原创

遵循EULAR的推荐能使脐带血中不存在或维持较低水平的TNF抑制剂,使婴儿的免疫系统免受影响。

    背景:早在妊娠第20周,肿瘤坏死因子抑制剂(TNFi)就可以主动转运的方式通过胎盘,由胎儿Fc受体介导并依赖于TNFi的结构。欧洲风湿病协会联盟(EULAR) 基于有限的证据建议在孕龄20周时停用阿达木单抗和英夫利昔单抗,在孕龄30-32周时停用依那西普,并有条件地继续使用赛妥珠单抗聚乙二醇。目前数据只证明赛妥珠单抗聚乙二醇在整个妊娠期间继续治疗时,脐带血浓度维持在最低水平。该研究通过分析脐带血中的TNFi 浓度来验证EULAR的建议可靠性。

    方法:患者来自活动性类风湿关节炎研究中的孕前咨询。EULAR推荐的时间点停止TNFi。收集母体血液和脐带血并分析TNFi的浓度。

    结果:111 名患者符合分析条件。TNFi的中位停止时间点如下:赛妥珠单抗聚乙二醇-孕龄37.0 周,依那西普-孕龄25.0周,阿达木单抗-孕龄19.0周和英夫利昔单抗-孕龄18.4 周。5.9%的脐带血样本中可检测到赛妥珠单抗聚乙二醇(n=68),中位浓度为 0.3 µg/mLIQR0.2-1.3),中位脐带/母体浓度比为 0.010。在任何脐带血样本中均未检测到依那西普 (n=30)。在48.0%的脐带血样本中可检测到阿达木单抗(n=25),中位浓度为 0.5 µg/mL (IQR: 0.20.7),中位浓度比为0.062 (IQR: 0.0180.15)。在57.1%的脐带血样本中可检测到英夫利昔单抗 (n=14),中位浓度为0.4 µg/mL (IQR: 0.11.2),中位浓度比为 0.012 (IQR: 0.0060.081)

    结论:遵循EULAR的推荐能使脐带血中不存在或维持较低水平的TNFi,暗示婴儿的免疫系统可能没有受影响。 

 

    出处:Ghalandari N, Kemper E, Crijns I(, et al. Analysing cord blood levels of TNF inhibitors to validate the EULAR points to consider for TNF inhibitor use during pregnancy. Annals of the Rheumatic Diseases 2022;81:402-405.

 

 

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    2023-01-06 jklm09
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    2022-03-28 snowpeakxu
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    2022-03-28 muzishouyi
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