Infliximab
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Infliximab can be used in pregnancy to treat inflammatory illnesses. Babies who were exposed in later pregnancy might be offered some of their vaccinations at a later time than usual.
What is it?
Infliximab (Remsima®, Flixabi®, Inflectra®, Remicade®, Zessly®) dampens the immune response. It is used to treat some autoimmune diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, psoriasis, Crohn’s disease, and ulcerative colitis.
Benefits
What are the benefits of using infliximab in pregnancy?
Infliximab helps to stop the immune system from attacking the body. It controls the unpleasant and often disabling symptoms of some autoimmune diseases and helps to prevent ongoing damage to tissues and organs.
Risks
What are the risks of using infliximab in pregnancy?
The available data suggests that infliximab is unlikely to affect the baby’s development. There are reports of some babies being born with a low infant birth weight following infliximab exposure. However, it is unclear if this is caused by the drug itself or the underlying illnesses in pregnant women taking infliximab.
Infliximab used in later pregnancy can potentially affect the baby’s immune system for several months after birth. Live vaccines should be avoided during this time. This means that the baby cannot be vaccinated against rotavirus (as this needs to be completed by four months) and is unlikely to be offered the BCG vaccine (if required) until they are at least six months old. A doctor will be able to advise about the best time for the baby to be given any live vaccinations.
Alternatives
Are there any alternatives to using infliximab in pregnancy?
Possibly. Other immunosuppressant medicines can be used in pregnancy so switching to a different drug may be an option. Some women may also find that their illness improves by itself as pregnancy progresses and so a specialist may advise that treatment can be reduced.
Women on infliximab who are planning a pregnancy or who accidentally conceive should arrange to see their doctor or specialist as soon as possible. This is to check whether infliximab is still the best treatment and to make sure the dose is correct.
No treatment
What if I prefer not to take medicines during pregnancy?
Pregnant women who have poorly controlled autoimmune disease may be at risk of adverse pregnancy outcomes, including miscarriage, preterm delivery, and low infant birth weight. To help reduce the chance of these outcomes and to stop an autoimmune disease from flaring, some women will be advised to continue taking infliximab in pregnancy. A doctor will only prescribe medicines when necessary and will be happy to talk through any concerns.
Will I or my baby need extra monitoring?
As part of routine antenatal care, most women will be offered a very detailed scan at around 20 weeks of pregnancy to check the baby’s development. Women taking infliximab may be offered extra monitoring of the baby’s growth.
Are there any risks to my baby if the father has used infliximab?
There is currently no evidence that infliximab used by the father can harm the baby through effects on the sperm.
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.