Authors: Chaparro M et al. Summary: This article reported results from the retrospective multicentre European TEDDY study, in which 381 children from mothers with IBD who had received anti-TNFα medication (with or without thiopurines) during pregnancy or within 3 months preconception were compared with those (n=453) from mothers who had not received such treatment; median follow-up periods for these two groups were 47 months and 68 months, respectively. Both univariate and multivariate analyses revealed similar incidence rates of severe infections in exposed and nonexposed children (2.8% and 1.6% per person-year, respectively), with preterm delivery the only variable associated with increased severe infection risk, of 2.5%, in the multivariate analysis.
Comment: Anti-TNF agents are rapidly forming the backbone of treatment for IBD. Because both UC and CD affect adolescents and young adults, management of fertility and pregnancy as well as the neonatal period in these populations forms an important part of clinical practice for most physicians active in the IBD space. Anti-TNF drugs can cross the placenta from the latter part of the second trimester of gestation, although they seem to be safe, at least in the short term. Given that small amounts of the agent can be transferred in breastmilk, the data from the European TEDDY study are an important contribution to the literature. Of the adverse events associated with anti-TNF agents, serious infection is a feared complication, and the TEDDY cohort included children from mothers with IBD being treated with anti-TNFα agents, compared with those children of mothers with IBD not treated with anti-TNFα agents. No difference was found in the analysis of the two groups, with the rate of severe infections found to be similar in exposed and nonexposed children (2.8% vs. 1.6% per person-year; hazard ratio 1.2 [95% CI 0.8–1.8]).
Reference: Am J Gastroenterol 2018;113:396–403