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P560. Anti-TNF is safe to stop in the second trimester of pregnancy in IBD women in remission

A. de Lima1, Z. Zelinkova1,2, C. van der Ent1, C.J. van der Woude1, 1Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands, 2University Hospital, 5th Department of Internal Medicine, Gastroenterology Unit, Bratislava, Slovakia

Background

Anti-TNF is relatively safe during pregnancy in Inflammatory Bowel Disease (IBD) females. Continuation of anti-TNF during pregnancy is related to high anti-TNF in the newborn and might have immunological consequences. We earlier reported that stopping around week 24 seems feasible and safe. In this study, we further evaluated the maternal safety of discontinuing anti-TNF in the 2nd trimester and compared relapse between females that stopped and continued anti-TNF.

Methods

Out of a prospective cohort of 210 pregnant IBD patients (pts), all pts on anti-TNF were selected. IBD pts in remission around gestational week 20 stopped anti-TNF before gestational week 25 (study group), and IBD pts not in remission around week 20 continued anti-TNF until at least week 30 (control group). Disease activity and pregnancy outcomes were compared between the study and the control group.

Results

The study and control group were drawn from a population of 210 pregnant IBD pts. Anti-TNF was used in 74 pregnancies [44 infliximab (IFX), 30 adalimumab (ADA)], resulting in 59 live births, 12 miscarriages, 1 elective abortion and 2 pts were still pregnant at the time of analysis. In the study group, 32 pts stopped anti-TNF before week 25 and in the control group 22 pts continued anti TNF until at least week 30. Reasons for continuation included disease activity around week 20 (n = 6), anti-TNF start in first trimester (n = 1) and difficult to control disease (n = 15). Median gestational week of anti-TNF cessation was 22 weeks (IQR: 12–29). A total of 8 pts in the study group had concomitant drugs [aminosalicylates (n = 2), corticosteroids (n = 1), azathioprine (n = 5)], compared to 6 women in the control group [azathioprine (n = 6) combined with aminosalicylates (n = 1) and corticosteroids (n = 1)] (p = 1.000). In the study group, 2 pts relapsed in week 30 and 36 after anti-TNF cessation in week 22, while in the control group 1 pt relapsed (p = 1.000). There were no significant differences in birth weight, gestational term, congenital abnormalities and APGAR scores between the study and the control group. As reported previously, the anti-TNF levels in the cord blood from children from females that stopped anti-TNF prior to week 25 were significantly lower compared to females that continued anti-TNF until the 3rd trimester (1.48 µg/ml vs 8.65 µg/ml, p > 0.0001).

Conclusion

Anti-TNF is safe to stop in the 2nd trimester in IBD women in sustained remission. Anti-TNF cessation before gestational week 25 is not associated with a higher risk of relapse compared to women who continue anti-TNF treatment.