Kommersiellt obunden läkemedelsinformation riktad till läkare och sjukvårdspersonal

Infliximab

Klassificering: 2

Preparat: Flixabi, Inflectra, Remicade, Remsima, ZESSLY

ATC kod: L04AB02

Substanser: infliximab

Råd till allmänheten

Kontakta läkare för diskussion innan behandling påbörjas.

För hälso- och sjukvården

Rekommendation

Risken för ett friskt fullgånget barn bedöms vara låg vid terapeutiska doser. Den eventuella lokaleffekten på immunsystemet i barnets tarm är okänd.

Bakgrund

Passerar över, eller är ej detekterbar, i bröstmjölk (1-6,8-10,19) men en relativ barndos kan inte beräknas. Koncentrationer upp till 1700 ng/mL kunde detekteras hos ett barn (modern hade 78 300 ng/mL) (1).  Infliximab var icke detekterbart hos två barn (4). Inga negativa effekter har rapporterats hos 39 ammade barn (1,4,5-7,11-18).

Uppdaterat: 2019-08-22

Referenser

Dokumentationsgrad: 2
  1. Fritzsche J, Pilch A, Mury D, Schaefer C, Weber-Schoendorfer C. Infliximab and adalimumab use during breastfeeding. J Clin Gastroenterol. 2012;46:718-9. PubMed
  2. Ben-Horin S, Yavzori M, Kopylov U, Picard O, Fudim E, Eliakim R et al. Detection of infliximab in breast milk of nursing mothers with inflammatory bowel disease. J Crohns Colitis. 2011;5:555-8. PubMed
  3. Grosen A, Julsgaard M, Kelsen J, Christensen LA. Infliximab concentrations in the milk of nursing mothers with inflammatory bowel disease. J Crohns Colitis. 2014;8:175-6. PubMed
  4. Kane S, Ford J, Cohen R, Wagner C. Absence of infliximab in infants and breast milk from nursing mothers receiving therapy for Crohn's disease before and after delivery. J Clin Gastroenterol. 2009 Aug;43(7):613-6. PubMed
  5. Stengel JZ, Arnold HL. Is infliximab safe to use while breastfeeding? World J Gastroenterol. 2008 May 21;14(19):3085-7. PubMed
  6. Vasiliauskas EA, Church JA, Silverman N, Barry M, Targan SR, Dubinsky MC. Case report: evidence for transplacental transfer of maternally administered infliximab to the newborn. Clin Gastroenterol Hepatol. 2006;4:1255-8. PubMed
  7. Correia LM, Bonilha DQ, Ramos JD, Ambrogini O, Miszputen SJ. Inflammatory bowel disease and pregnancy: report of two cases treated with infliximab and a review of the literature. Eur J Gastroenterol Hepatol. 2010 Oct;22(10):1260-4. PubMed
  8. Mahadevan U, Kane S, Sandborn WJ et al. Intentional infliximab use during pregnancy for induction or maintenance of remission in Crohn's disease. Aliment Pharmacol Ther. 2005;21:733-8. PubMed
  9. Peltier M, James D et al. Infliximab levels in breast-milk of a nursing Crohn's patient. Am J Gastroenterol. 2001;96 (9 suppl 1):S312. Abstract.
  10. Forger F, Matthias T, Oppermann M et al. Infliximab in breast milk. Lupus. 2004;13:753. Abstract.
  11. Matro R, Martin CF, Wolf DC et a. Detection of biologic agents in breast milk and implication for infection, growth and development in infants born to women with inflammatory bowel disease: Results from the PIANO registry. Gastroenterology. 2015;148:S141 Abstract.
  12. Steenholdt C, Al-Khalaf M, Ainsworth MA, Brynskov J. Therapeutic infliximab drug level in a child born to a woman with ulcerative colitis treated until gestation week 31. J Crohns Colitis. 2012;6:358-61. PubMed
  13. Vestergaard T, Kammerlander H, Brock B, Julsgaard M. Immunoglobulin and Infliximab Concentrations in Dichorionic Twins Exposed to Infliximab in Utero. J Crohns Colitis. 2017;11:1152-1153. PubMed
  14. Tursi A. Effect of intentional infliximab use throughout pregnancy in inducing and maintaining remission in Crohn's disease. Dig Liver Dis. 2006;38:439-40. PubMed
  15. Bernard N, Garayt C, Chol F, Vial T, Descotes J. Prospective clinical and biological follow-up of three breastfed babies from azathioprine-treated mothers. Fundam Clin Pharmacol 2007;21(Suppl 1):62-3.
  16. Mahadevan U, Kane SV, Church JA, Vasiliauskas EA, Sandborn WJ, Dubinsky MC. The effect of maternal peripartum infliximab use on neonatal immune response. Gastroenterology. 2008;134 (Suppl 1):A69.
  17. Hou JK, Mahadevan U. A 24-year-old pregnant woman with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2009;7:944-7. PubMed
  18. Lund T, Thomsen SF. Use of TNF-inhibitors and ustekinumab for psoriasis during pregnancy: A patient series. Dermatol Ther. 2017;30:e12454. PubMed
  19. Matro R, Martin CF, Wolf D, Shah SA, Mahadevan U. Exposure Concentrations of Infants Breastfed by Women Receiving Biologic Therapies for Inflammatory Bowel Diseases and Effects of Breastfeeding on Infections and Development. Gastroenterology. 2018. PubMed

- Författat av Klinisk farmakologi, Karolinska Universitetssjukhuset för Hälso- och sjukvårdsförvaltningen, Region Stockholm. Janusmed amning uppdateras kvartalsvis.

Fasstexter