Selecting Therapies for CD in Pregnancy

Transcript

David Hudesman, MD: Millie, why don't we continue down that route. For your pregnant patients, what's important, what therapies would you consider or not consider?

Millie Long, MD, MPH: One of the things that is important is if we do feel that the biologic agents are safe here, and there is robust data on anti-TNFs. Really the children are now being followed out for years. We have 4-year data out in the PIANO registry and no congenital abnormalities, normal developmental milestones, just no signs of increased infectious complications. Even for a TNF, if a child is exposed in utero, they may have a detectable level for the first 6 months, but we haven't seen consequences associated with that. The big thing in that scenario is not giving live vaccines during that period; nothing else that needs to be done differently, including children who attend daycare, don't have increased complications. I think that the key point is that a mother exposed to a biologic should not change any of their planning surrounding fertility, pregnancy, or anything like that. Certainly we have good level data associated with ustekinumab and vedolizumab; risankizumab is a little newer, so we don't, but in theory, this is an lL 23 mechanism that should demonstrate similar safety during pregnancy, but our registries will help to demonstrate that. I'm very comfortable with those. I know we're talking about Crohn's here rather than UC, but we don't have pregnancy data surrounding the JAK inhibitors or the S1Ps. It's not necessarily that these are going to be bad, it's just we don't have the data right now. In animal models at much higher dosing, there may be some areas of concern, so that's why we want to study it. I don't preferentially put a young woman who tells me I want a pregnancy in the next year on an S1P or a JAK, that's something that I would go more in the biologic realm.

Transcript edited for clarity.