Tocilizumab

(Date: May 2020. Version: 1)

This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.

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What is it?

Tocilizumab is a type of medicine called a monoclonal antibody. It is used to treat rheumatoid arthritis. Tocilizumab is also being used in clinical trials to see if it can be used to treat coronavirus (COVID-19).

Is it safe to use tocilizumab in pregnancy?

When deciding whether to use tocilizumab during pregnancy it is important to weigh up the potential benefits to your health and wellbeing against any possible risks to you or your baby, some of which may depend on how many weeks pregnant you are. Your doctor or specialist will be able to help you make decisions about your treatment.

What if I have already used tocilizumab during pregnancy?

If you are taking any medicines while pregnant, you can discuss this with your doctor. You can then decide together whether ongoing treatment is appropriate, and if so, your doctor will ensure that you are taking the most effective dose.

Can using tocilizumab in pregnancy cause birth defects in the baby?

A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects.

There are currently no concerns that tocilizumab causes birth defects. However, data is limited to approximately 350 pregnancies. Further data collection is required to support this finding.

Can using tocilizumab in pregnancy cause miscarriage?

There is no evidence that tocilizumab use in pregnancy is linked to miscarriage. However, the evidence is limited to a relatively small number of pregnancies.

Can using tocilizumab in pregnancy cause stillbirth, preterm birth, or my baby to be small at birth (low birth weight)?

The majority of tocilizumab-exposed babies were born at full-term and with normal birth weights. There is not enough evidence to say whether tocilizumab is linked to stillbirth, preterm birth, or low birth weight in the baby. Although there are some case reports of babies being born earlier and with low birth weights, the illnesses in the mothers that tocilizumab was being used to treat are likely to have contributed to these findings.

Will my baby need extra monitoring?

As part of routine antenatal care, most women will be offered a scan at around 20 weeks of pregnancy to look for any problems with the baby. Women who have used tocilizumab may be offered more detailed scans by their doctor. Extra growth scans may be needed due to the underlying conditions that tocilizumab is used to treat.

Are there any risks to the baby after delivery?

Tocilizumab works by changing the immune system. We do not know the effect of this in the newborn baby. As a precaution it is advised that the baby does not receive live vaccines for 6 months following birth. Most vaccines are not live and can therefore be given as normal, however vaccinations against tuberculosis and rotavirus should be delayed. Provided you are not in a high-risk group for tuberculosis, missing these vaccines will not put your baby at any particular risk. After 6 months your baby can have all vaccines as normal.

Are there any risks to my baby if the father has taken tocilizumab?

There is currently no evidence that tocilizumab used by the father can harm the baby through effects on the sperm, and most experts agree that this is unlikely.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet, please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.

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General information 

Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks.  They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.

Medicines use in pregnancy

Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby.  There are, however, some medicines that can harm a baby’s normal development.  How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.

If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.

When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.   

Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.

   

www.medicinesinpregnancy.org

Disclaimer: This information is not intended to replace the individual care and advice of your health care provider. New information is continually becoming available. Whilst every effort will be made to ensure that this information is accurate and up to date at the time of publication, we cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes following decisions made on the basis of this information. We strongly advise that printouts should NOT be kept for any length of time, or for “future reference” as they can rapidly become out of date.

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