Infliximab/remicade at 24 weeks

[Kerry]

Hi

I was diagnosed with crohns of the colon a year ago. I have been on infliximab since Feb 2012 and its working well. I am 17 weeks and 2 days pregnant with my first child after IVF.

Early on I was told i couldnt have infliximab after 24 weeks. My last infusion was 1 day before 16 weeks so im due 1 day before 24 weeks. I saw a feotal consultant yesterday as im classed as a high risk pregnancy (im 38 so that doesnt help). She said i should have my next infusion and that would be the last.

I also started Azathioprine 3 weeks ago. The idea being that as the infliximab wore off the aza would kick in. So i was hoping i wouldnt need the next infusion and im suprised the consultant has told me to have it.

She said something about it possibly affecting the heomoglobin of the baby? but she said studies were inconclusive.

Im worried ill be double dosing baby from about 24 weeks with infliximab and the Aza will have kicked in. Does it sound right i should have infliximab at 23weeks +6 days?

I feel fine by the way. Have been really since i went on infliximab and no symptoms at all during pregnancy - even have constipation sometimes. I still have things that make me feel ill if i eat them though and that has changed over the months but kicked in before i was pregnant - coconut, blueberries and anything sweet and tasty seem to make me feel unwell.

Im seeing my crohns consultant next week so would like to decide what my preference is before i go - have the last infliximab or not.

 

[Jennifer]

Hi Kerry, sorry for the late response. I don't know the answer to your question but I'm going to tag Judith in here in hopes that she may have an answer for you or possibly questions you can ask your doctor when you see them. Keep us posted!

 

[Judith]

Hi Kerry,
Congratulations on your new family member! I know firsthand how difficult IVF is...... I am so happy for your success!

The problem with medication use in pregnancy is mainly due to a lack of research and data on the subject. Many researchers avoid pregnant women in their studies (understandably), so there is a severe lack of information on the subject.

The mechanism of action in Remicade / Infliximab is different than in Azathioprine so I would not worry about a "Double Dose" type situation. However, any medication effects on the growing baby for each individual drug still apply......

Remicade / Infliximab is a Pregnancy Category B Drug. This basically states there is no "documented" toxicity. The term "documented" may be of note as it is a fairly new drug and information on the fetus is still being compiled. A couple of points that may be of interest:

1. Although literature is lacking on the topic, the data that do exist state its use in the first 2 trimesters is low risk. Some literature cites case reports of women having infusions until 2 weeks before term with no detrimental effects. Two case reports had the women taking infliximab and daily mesalamine throughout the pregnancy again with no negative effects.

There have been reports of developmental defects in women taking infliximab during pregnancy but at rates that are similar to those in women not on infliximab during pregnancy.

2. There appears to be more information showing developmental defects in women having severe Crohn's flares during pregnancy. It has been suggested more than once that the reduced Vitamin and Nutrient absorption seen in Crohn's flares may be responsible for more fetal abnormalities than an effective treatment keeping the mother in remission.

Often, if a woman conceives during remission she will remain in remission for the duration of the pregnancy.... so (without knowing the specifics of your health situation) the odds are in your favor.

Regarding your Azathioprine .... there are many women on Crohnsforum who swear by its use during pregnancy. It is a Pregnancy Category D medication. This essentially states that there is some evidence for an increased fetal risk with this medication. It is associated with lower birth weight and premature birth. Again, studies have largely shown a higher risk of uncontrolled Crohn's flares.

I am so sorry I dont have much to add on the subject. The fact that you have been in remission and continue to feel good is wonderful!

Please keep us updated on you and the little one.... and congratulations again!

 

[StaceyQ]

Congratrulations on your pregnancy and i hope everything goes well for you. Ask lots of questions to make sure you are happy x