Gebelik Sırasında Monoklonal Antikor Biyolojikleri Kullanan Kadınlarda Perinatal Sonuçlar

Öz

Amaç: Biyolojikler, sıklıkla monoklonal antikor biyolojikleri (mAbs) olarak bilinmekte olup, inflamatuvar ve otoimmün hastalıkların tedavisinde ve hastaların yaşam kalitesinde önemli iyileşmeler sağlamıştır. Hastalığın remisyonu, mAbs maruziyeti olan gebeliklerde perinatal sonuçların en güçlü belirleyicisidir. Bu çalışmanın amacı, mAbs tedavisi alan gebeliklerde maternal ve perinatal sonuçların değerlendirilmesidir Gereç ve Yöntemler: Bu çalışmada retrospektif olarak 21 tekil gebelik değerlendirildi. Gebelik boyunca ilaç kullanımı üç kategoriye ayrıldı: tüm trimesterlerde devam eden kullanım, birinci trimesterde sonlandırma ve üçüncü trimesterde sonlandırma. Monoklonal antikor biyolojikleri (mAbs), etki mekanizmaları temelinde Anti-TNF α, anti-sitokin ve anti-B hücre ajanları olarak sınıflandırıldı. Bulgular: Çalışma popülasyonunda en sık görülen altta yatan hastalık Ailevi Akdeniz Ateşi olarak saptandı. İlaç kullanımında Certolizumab pegol, en yaygın anti-TNF α ajanı; Anakinra ise en sık kullanılan anti-sitokin ajanıydı. Ortalama doğum yaşı 38±1,2 hafta ve ortalama doğum ağırlığı 3083±416 g olarak hesaplandı. Çoklu otoimmün veya inflamatuar hastalığı bulunan gebelerde, fetal büyüme kısıtlılığı, preterm doğum ve yenidoğan yoğun bakım ünitesine yatış oranları, böyle bir eşlik eden hastalığı olmayan gebelerle karşılaştırıldığında anlamlı derecede yüksek saptandı (p < 0,05). Sonuç: Çalışmamızın bulguları, birden fazla otoimmün veya inflamatuar hastalığa sahip olmanın, gebelikte olumsuz obstetrik sonuçların görülme sıklığını artırabileceğini göstermektedir.

Anahtar Kelimeler

• Monoklonal antikor
• biyolojik
• perinatal sonuç
• anti-TNF α
• Anakinra
• Certolizumab pegol

Perinatal Outcomes in Women Exposed to Monoclonal Antibody Biologics During Pregnancy

Abstract

Objective: Biologics, often known as monoclonal antibody biologics (mAbs), have improved the treatment and quality of life for many patients with inflammatory and autoimmune diseases. Disease remission is the strongest predictor of perinatal outcomes in pregnancies exposed to monoclonal antibodies. The aim of this study was to evaluate maternal and perinatal outcomes in pregnancies receiving mAbs therapy. Materials and Methods: We retrospectively reviewed 21 singleton pregnancies. Drug exposure during pregnancy was classified as: exposure throughout all trimesters, discontinuation in the first trimester, or discontinuation in the third trimester. mAbs drugs were classified into three groups based on their mechanism:Anti-TNF α, anti-cytokine, and anti-B cell agents. Results: The most common underlying disease was Familial Mediterranean Fever. Certolizumab pegol and Anakinra were the most frequently administered anti-TNF α and anti-cytokine agents, respectively. The mean gestational age at delivery was 38±1.2 weeks, and the mean birth weight was 3083±416 g. Rates of fetal growth restriction, preterm birth, and neonatal intensive care unit admission were significantly higher in patients with multiple autoimmune or inflammatory diseases compared with patients without such conditions (p < 0.05). Conclusion: This study demonstrated that the coexistence of multiple autoimmune or inflammatory diseases may be significantly associated with a higher incidence of adverse obstetric outcomes in pregnancy.

Keywords

• Monoclonal antibody
• biologics
• perinatal outcome
• anti-TNF α
• Anakinra
• Certolizumab pegol

Kaynakça

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