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• W2912292206 abstract "Background: Active Inflammatory Bowel Disease (IBD) during pregnancy is a risk factor for low birth weight, poor fetal outcome and premature delivery. Maintaining remission is critical, and medications targeting TNF-a, such as adalimumab, are most effective in treating Crohn's disease (CD). However, their safety and efficacy during pregnancy are not fully known. We report the failed use of adalimumab in maintaining remission during pregnancy in CD. Case: RL is a 21-year-old woman who was diagnosed with IBD at age 17 when she experienced bloody diarrhea and weight loss following a miscarriage. She developed toxic megacolon necessitating a total proctocolectomy with ileal pouch anal anastomosis. An anal fistula which progressed into an abscess ensued. Pouchoscopy showed an ulcerated inflow tract that more resembled CD than UC. RL was started on infliximab, 6MP and Prednisone without significant improvement. Infliximab was subsequently discontinued. Repeated pouchoscopy showed ulceration at the ileoanal anastomosis site and adalimumab was added. At age 20, RL was in remission and became pregnant while taking adalimumab and 6MP. She presented with a tender right groin lymph node 6 months later. The node developed into a nonhealing perianal abscess and was thought to be a pouch-vaginal fistula secondary to CD. Drainage of the abscess was recommended but she elected to have it deferred until delivery. Fetal development was normal and she had a C-section at 36 weeks. Discussion: Adalimumab's use in active CD during pregnancy has been described in several case reports, demonstrating success in attaining remission and preventing complications such as fistulas, strictures or abscesses. However, there have been no reports describing adalimumab's inability to control complications of CD during pregnancy. While adalimumab is rated pregnancy class B, crosses the placenta and has been identified in breast milk, it has not been shown to cause any adverse fetal events. Its efficacy remains unclear, as our patient manifested new fistulizing disease. A comparative registry evaluating the efficacy and toxicity of anti-TNF-a drugs is warranted. At this time, certolizumab, a pegalated anti-TNF-a drug, may be a good alternative during pregnancy, as it does not cross the placenta." @default.
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• W2912292206 date "2007-09-01" @default.
• W2912292206 modified "2023-10-14" @default.
• W2912292206 title "Failed Use of Adalimumab in Maintaining Remission in Crohnʼs Disease during Pregnancy" @default.
• W2912292206 doi "https://doi.org/10.14309/00000434-200709002-00558" @default.
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